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
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303-681-4932  phone
303-388-8727  fax

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.