Single Layer Versus Double Layer Closure of Uterus during Caesarean Section – A Prospective Study in Index and Subsequent Pregnancy

Background: Suturing of caesarean incision leads to reduction in maternal mortality, suturing can be done in either single layer or double layer. Many studies have shown both of them to be effective, with no conclusive evidence of preference of any one of them. The objective of this study was to compare method of uterine closure by single-layer and double-layer closure keeping in mind the intraoperative and postoperative morbidity in index pregnancy and risk of uterine rupture in future pregnancy. Methods: This prospective randomized controlled study was done from March 2007 to January 2009, a total of 357 women were enrolled for lower segment caesarean section either to single layer (n=188) or double layer (n=169) closure of uterine incision. Primary outcome measures studied were operating time, intraoperative blood loss, and febrile morbidity in index pregnancy and chances of uterine rupture in subsequent pregnancy. Secondary outcome measures were cystitis, wound infection and hospital stay. Results were compared by Chi-square test. Results: Patients with single layer closure had significantly (p<0.05) less operative time and estimated blood loss as compared to double layer closure. There was also a statistically significant (p<0.05) difference in febrile morbidity and hospital stay in single layer closure of uterus. There was however no significant difference in other variables also, in subsequent pregnancy with previous caesarean section there was no difference in pregnancy outcome in both groups was not statistically significant (p-value>0.05). Operative findings in subsequent pregnancy don’t differ much. Conclusions: Single layer closure was associated with lesser operating time, intra-operative blood loss, febrile morbidity and hospital stay in index pregnancy as compared to double-layer closure.