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Evidence Library · Closing

Closing the uterus and the skin

Small technical choices with long-term consequences.

The uterus is usually closed in one or two layers. The choice may affect how the scar heals and how likely a pocket, or niche, forms in the wall. That is covered in the next-pregnancy stage.

The fat layer. When it is more than 2 cm thick, closing it with stitches reduces the wound coming apart. In a meta-analysis, the wound disruption risk fell by about a third (relative risk 0.66), with an absolute risk reduction of 6.2%, meaning about 16 women need this step for one to avoid a wound opening.

The skin. A meta-analysis of 5 trials and 877 women found more wound complications with staples than with a subcuticular stitch (odds ratio 2.12), and more wound separation (odds ratio 4.07), though staples saved about 5 minutes of operating time. That review reports odds ratios without pooled absolute rates for either group.

Where this comes from:
313. Chelmow D, Rodriguez EJ, Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol. 2004;103(5 Pt 1):974-980.
314. Clay FS, Walsh CA, Walsh SR. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2011;204(5):378-383.

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