Risk of uterine rupture following locked vs unlocked single-layer closure.

OBJECTIVE To compare the rate of uterine scar disruption after a locked versus an unlocked single-layer closure of the hysterotomy incision at a previous cesarean. METHODS A retrospective cohort study in a population where both locked and unlocked single-layer closure are commonly used. All singleton pregnancies at 24 weeks' gestation or more with a previous single cesarean were included. Rate of uterine scar disruption (complete uterine rupture and uterine scar dehiscence) were compared between women with a previous locked and those with a previous unlocked single-layer closure of the uterus. RESULTS Out of 388 women included in the study, 272 had a previous unlocked single-layer closure and 116 had a locked single-layer closure. We found no significant difference in the rate of uterine scar disruption between the two groups (5.9% vs 8.6%, p = 0.32). CONCLUSION Locking a single-layer closure was not associated with an increase rate of uterine scar disruption at the next pregnancy in our retrospective analysis. A randomized trial should be performed.