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Le rôle de la fermeture utérine en un seul plan sur le risque de rupture utérine lors d'une prochaine grossesse
| Content Provider | Semantic Scholar |
|---|---|
| Author | Bujold, Emmanuel |
| Copyright Year | 2009 |
| Abstract | OBJECTIVE: Uterine rupture is one of the worst obstetrical emergencies. Recently, studies with small sample size suggested that the type of uterine closure could be associated with uterine rupture. Therefore, we aimed to evaluate the impact of a prior single-layer versus a double-layer closure on the risk of uterine rupture. STUDY DESIGN: A multicentre case-control study of women with a single prior low transverse cesarean (LTCS) who experienced a complete uterine rupture during a trial of labor (TOL) was performed. For each case, three women who underwent a TOL without uterine rupture after a prior LTCS were selected as controls. Risk factors such as type -of prior closure (singlevs double-layer), suture material (vicryl vs chromic), prior cesarean for arrest disorder, diabetes, prior vaginal delivery (before or after the previous cesarean), labor induction, cervical ripening, birthweight, prostaglandin use, maternaI age and weight, gestational age and interdelivery interval, were compared between the groups. Logistic regression analyses were performed. RESUL TS: Ninety-six cases of uterine rupture including 28 withadverse neonatal outcome, and 288 controls were analyzed. In univariate analyses, single-layer closure, short interdelivery interval, labor induction with cervical maturation or labor induction with unfavourable cervix, use of oxytocin, and birthweight greater than 3500 grams were aIl associated with an increased risk of uterine rupture, while a prior vaginal birth had a protective effect. In multivariate analyses, only a single-layer closure (O.R.2.22, 95%C.I.: 1.23-4.01) and a birth weight greater than 3500 grams (O.R.2.01, 95%C.I.: 1.223.30) were associated with increased rates of uterine rupture while a prior vaginal birth remained a protective factor (O.R. 0.49, 95%C.I.:0.25-0.95). A single-layer closure was also related to uterine rupture associated with adverse neonatal outcome (O.R. 2.92, 95%C.I.: 1.02-8.33). CONCLUSION: A prior single-layer closure is associated with more than twice the risk of uterine rupture compared to a double-layer closure. Single-layer closure should therefore be avoided in women who could contemplate future vaginal birth after cesarean (VBAC). |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://corpus.ulaval.ca/jspui/bitstream/20.500.11794/20852/1/26285.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
