ONE VERSUS TWO LAYERS CLOSURE OF A lOW TRANSVERSE UTERINE INCISION IN • CAESAREAN SECTION ..

Abstract

Caesarean section is the delivery of a viable fetus through incision in the abdominal wall ( Laparotomy) and the uterine wall ( hystrotomy) (Clark, 1995). It has increased rate over the past 2 decades and now has reached a plateou rate about 20 - 25%. (Cunninghum et al., 1997). Control of bleeding and approximation of incised tissue edges are the two cardinal principles of any operation. It is also important, whenever possible, to shorten the operation time, uses less suture material and diminishes tissue ischemia without compromising the patient safety. ( Malkamy, 1993)

In general, abdominal incision used for most genealogical and obstetrics procedures can be divided into midline vertical incision or transverse incision which is more cosmetic more stronger with less likelihood of dehiscence or hernia formation. (Hankins,1995). A low transverse uterine incision is most commonly performed now but a vertical incision may be used in special consideration. (Clark, 1995). The uterine incision is closed in one or two layers. The initial suture is placed just beyond one angle of the incision. A running lock suture is then carried out with each suture penetrating the full thickness of the myometrium the running lock suture is continued just beyond the opposite incision angle.(Pitchard,1997). Especially when the lower segment is thin, satisfactory approximation of the cut edges usually can be obtained with one layer of suture.