Single-versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions

The risk of postoperative pelvic and abdominal adhesions is increased among women with repeat cesarean delivery. Several studies have addressed the role of single- versus double-layer uterine incision closure at the time of cesarean delivery to reduce maternal and neonatal morbidity. This retrospective study was a secondary analysis of the data in the previous prospective cohort trial that evaluated the effect of parietal peritoneal closure on the development of adhesion formation in women undergoing a first repeat cesarean. The aim of this investigation was to determine whether single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary cesarean delivery were associated with subsequent adhesion formation at the time of repeat cesarean delivery. Patient records of 127 pregnant women from the primary caesarean delivery were reviewed to identify whether single- or double-layer hysterotomy closure had been performed. The main study outcome measure was the frequency of pelvic and abdominal adhesions. Multivariable logistic regression analysis was used to control for potential confounders. At the time of primary cesarean section, 56 (44%) of the 127 women had single-layer hysterotomy closure and 71 (56%) had double-layer closure. The single-layer procedure was associated with significantly more bladder adhesions at the time of repeat cesarean compared with the double-layer technique (24% versus 7%, P = 0.01). After adjustment for potential confounding factors, the odds of bladder adhesions were 7 times greater with single-layer hysterotomy closure (odds ratio, 6.96; 95% confidence interval, 1.72-28.1). No differences were found between the 2 procedures in the frequency of adhesions at other surgical sites. These findings show that bladder adhesions occurred more frequently during repeat cesarean deliveries with primary single-layer hysterotomy closure than with the double-layer technique.