The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62073

Ina May Gaskin, CPM, The Farm Midwifery Center, 41, The Farm, Summertown, TN 38483, 931 964 2519, midwifeim@earthlink.net and Kenneth C Johnson, PhD, Epidemiologic Consultant, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada.

In the early 1990s, many US obstetricians began a new way of repairing the uterine incision after cesarean section, believing that it might prevent maternal morbidity related to prolonged operating time. The new method calls for repairing the uterus in one layer of suturing instead of the two layers previously thought necessary. Repairing the incision in two layers thickens the tissue that ultimately makes the lower uterine segment scar. One-layer suturing is reported to save five minutes per operation.

By the end of the 1990s, a significant percentage of the cesarean sections performed annually were repaired with the new suturing method. The Cochrane Database of Systematic Reviews 2000 found only two studies (involving just 382 women with 1-layer closures) meeting their criteria for evaluating surgical procedures and drugs. Neither study could apply to questions of maternal safety. Then a 2002 Montreal study of 2,142 women compared the new method with the old and found four times higher risk of uterine rupture with the 1-layer method. A noted pathologist has also raised concerns about the possibility of increased abnormal placentation associated with the new surgical method. In his 4th edition of The Pathology of the Human Placenta, Kurt Benirschke, MD, wrote: "The reason why placenta percreta is now so common undoubtedly relates to the greater frequency of cesarean sections. But what is it that causes percretion? In our view it is the manner in which the uterus is repaired and reconstituted after section."

Learning Objectives:

• Learning Objectives
• At the conclusion of the session, the participant in this session will be able to:
• 1. Discuss the strengths and weaknesses of the studies done to date on the 1-layer suturing method.
• 2. Articulate the epidemiologic and public health issues surrounding 1-layer suturing for childbearing women.
• 3. List the studies performed to date which address the maternal risks in pregnancies following a cesarean section.
• Teaching Objectives
• 1. Catalog of studies comparing 1-layer and 2-layer suturing
• 2. Discussion of ethical questions surrounding the wholesale adoption of a new surgical technique with a small research base.
• 3. Discussion of the research questions related to the 1-layer method of suturing that should be answered in future research.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.