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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Nov 19
    2009

    VBAC with history of single layer repair of incision

    Archived User

    Dear Ms. Goer,
    I am seeking clinical evidence and/or information regarding risk of uterine rupture in labor in a client with a history of a c-section and a single layer repair of her incision.  I have a home birth practice and have cared for many women who have given birth vaginally after having had a previous baby by c-section.  This client is seeking to be comfortable with a home VBAC.  I too would be interested to know if women with a single layer repair are at greater risk and if so, to what degree.  I would appreciate any information you can provide.

    Thank you,
    Janet Schwab, MSN, CNM
    To Each Her Own Women's Health Services, LLC
    www.2eachherown.com
    [login to unmask email]
    303-681-4932  phone
    303-388-8727  fax

    Henci Goer

    To answer your question, I'm going to insert the relevant excerpt from the mini-reviews section of the VBAC chapter in my forthcoming book, Optimal Care in Childbirth: The Case for a Physiologic Approach. (The new edition will be co-authored by Amy Romano and published by Classic Day Publishing.) I took the lead on the VBAC chapter, and one of my goals was to quantify risks wherever I could. Questions such as yours validate the many hours I spent poring over studies and compiling data.

    -- Henci

    Single-layer uterine suturing: 0-3.1% range in scar rupture rate. The largest study reported a rate of 3.1% with single-layer closure (15/489) vs. 0.5% with double-layer suturing (8/1491). Single-layer closure remained a factor after accounting for confounding variables. A case-control study of factors associated with 96 cases of scar rupture during VBAC labor after one prior cesarean vs. 288 similar women with no scar rupture found single-layer suturing to be an independent risk factor after adjusting for birth weight, interdelivery interval, induction with an unfavorable cervix, oxytocin use for induction or augmentation, and gestational age 41 w or more.

     

    Bujold E, Goyet M, Marcoux S, et al. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol 2010;116:43-50.

    Bujold E, Hammoud A, Schild C, et al. The role of maternal body mass index in outcomes of vaginal births after cesarean. Am J Obstet Gynecol 2005;193(4):1517-21.

    Chapman SJ, Owen J, Hauth JC. One- versus two-layer closure of a low transverse cesarean: the next pregnancy Obstet Gynecol 1997;89(1):16-8.

    Tucker JM, Hauth JC, Hodgkins P, et al. Trial of labor after a one- or two-layer closure of a low transverse uterine incision Am J Obstet Gynecol 1993;168(2):545-6.

     


    All Times America/New_York

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