Accepted Manuscript Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and meta-analysis Stéphanie Roberge , MSc Suzanne Demers , MD Vincenzo Berghella , MD Nils Chaillet , PhD Lynne Moore , PhD Emmanuel Bujold , MD, MSc PII:

S0002-9378(14)00575-4

DOI:

10.1016/j.ajog.2014.06.014

Reference:

YMOB 9874

To appear in:

American Journal of Obstetrics and Gynecology

Received Date: 14 March 2014 Revised Date:

28 May 2014

Accepted Date: 5 June 2014

Please cite this article as: Roberge S, Demers S, Berghella V, Chaillet N, Moore L, Bujold E, Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and meta-analysis, American Journal of Obstetrics and Gynecology (2014), doi: 10.1016/j.ajog.2014.06.014. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and meta-analysis Stéphanie

ROBERGE,

MSc1,

Suzanne

DEMERS,

MD1,2,

Vincenzo

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BERGHELLA, MD3, Nils CHAILLET, PhD4, Lynne MOORE, PhD1, Emmanuel BUJOLD, MD, MSc1,2 1

Department of Social and Preventive Medicine, Faculty of Medicine, Université

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Laval, Quebec, QC, Canada 2

Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, QC, Canada

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Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA

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Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, QC, Canada

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Corresponding author:

Emmanuel Bujold, MD, MSc, FRCSC

Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval,

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2705 boulevard Laurier, Québec, QC, Canada G1V 4G2; email: [email protected]

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Word count:

Abstract: 240

Manuscript: 2,114

Disclosure statement All authors report that they have no potential conflicts of interest.

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ACCEPTED MANUSCRIPT

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Short title: Uterine closure and adverse maternal outcomes

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Condensation: This review estimates the effect of single- vs double-layer uterine closure at cesarean on the risk of postoperative complications and uterine scar defect.

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ACCEPTED MANUSCRIPT

Abstract A systematic review and meta-analysis were performed through electronic

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database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, that compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were

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included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical

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procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy and uterine scar evaluation by ultrasound. Twenty out of 1,278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-

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layer closure that had shorter operative time (-6.1 minutes, 95% confidence interval (CI) -8.7 to -3.4, p