Comparative study of short term outcome of Single layer uterine closure versus double Layer uterine closure in lower segment Caesarean section

AIM OF THE STUDY: To compare the short term outcome of single layer closure of uterine incision from the double layer closure of uterine incision in lower segment caesarean section. PERIOD OF STUDY: January 2013 to December 2013. SAMPLE SIZE: 200 subjects – 100 subjects randomized to single layer closure with vicryl with non closure of peritoneum and 100 subjects to double layer closure with peritoneal closure. SOURCE OF DATA: From the Dept. of Obstetrics & Gynaecology, Institute of Obstetrics & Gynaecology, Egmore, Chennai. RESULTS: The results of the study was the incidence was 34.4%. The maternal age, parity, type of operation, booking status did not show any difference in both the groups. The common indication of caesarean section was cephalo pelvic disproportion other indications was previous caesarean section ,fetal distress, failed Induction ,malpresentation like breech, tranverse lie, etc. The mean duration of surgery is 29.91 minutes in the study group and 37.56 minutes in the double groups and the average reduction in 7.6 minutes in the single layer groups with a significant p value of 0.000. The single layer uterine closure groups needed 1 to 2 extra hemostatic sutures whereas the control group needed 2 to 3 sutures with a p value of 0.000. The perioperative hb fall in the study group was 0.86 and 0.94 in the control group with a significant p value of 0.058. Number of analgesics required in the study group of 1 to 2 doses and 2 to 3 in the control group. The febrile morbidity was 4% and 5% in both the groups. Wound infection was 4% and 8% in both the groups out of which 1 case required wound resuturing in the study group and 3 cases in the control groups. Each had 1 case of cystitis and 2 cases of paralytic ileus. The ambulation and duration of hospital stay was less in the study group compared with the double layer group. CONCLUSION: Hence single layer uterine closure when compared with double layer closure had reduced duration of surgery ,reduced perioperative Hb fall, reduced postoperative pain ,reduced need of extra hemostatic sutures with all bearing statistical significance and reduced febrile morbidity and wound infection in the single layer groups and hence reduced overall cost effective ratio