Residency 2014-15

Residency 2014-15
Home of the Best OB/GYN Residency Program in the Country

Wednesday, July 14, 2010


The residents had a journal club last week regarding the recent Green Journal article on double vs. single-layer closure of the uterus. Dr. Alison moderated the discussion and Dr. Mei Ling Hua was the R3 assigned to lead the discussion. Below are Dr. Hua's conclusions.

-This was a multicenter case control study to look at the effect of hysterotomy closure type on the risk of uterine rupture during VBAC.
-There are many risk factors that contribute to risk of uterine rupture during VBAC -Hysterotomy closure type (single-layer vs double-layer) is a modifiable risk factor -This study found a 2-fold increased risk of uterine rupture with single layer closure, even after adjusting for confounding variables.
-Strengths: multicenter, large number of cases, strict definition of uterine rupture, control group well selected (3 controls per case; matched for time period and institution, but delivered prior to case of uterine rupture)
-Weaknesses: Retrospective design, no information on doseages of OT or prostaglandin, and whether used consecutively, no definition of double-layer closure, no info on what the confounding variables were.
-Impact: Absolute risk of uterine rupture is low and performing a double-layer closure is not without risk. A randomized control trial would be a better way to answer this question, but would be expensive.

No comments:

Post a Comment