Help with medical records

[newmommy27]

Ok so I intend to vbac this baby and was hoping someone could decipher if I have had a double or single suture...

"the repair of the uterine incision was carried out using a running locking suture of 0 Maxon. No additional suture were required for this single layer closure." it goes on to say... "the wound was inspected once more and there was good homeostasis. The anterior peritoneum was re-approximated using a running suture of 3-0 Vicryl and the subfascial tissues and rectus muscle were homestatic prior to the closure of fascia overlying these using a running suture of 0 Vicryl."

Looking forward to your insights

-Lori

[newmommy27]

really mamas....no insights...

where are all you midwives there really can't be that many babies being born tonight

[Jane]

It's pretty clear to me - what are you looking for?
1. A running, locking stitch closed the uterus, using with Maxon brand/type suture material.
2. A single layer closure was used
3. After doing a few other things, the uterus was re-inspected and still not bleeding - all was good
4. The peritoneum was closed with stitches- this step is believed to help prevent some adhesions. It's the layer between the organs and the muscles - the sack the organs live inside, sorta.
5. The muscles were then stitched, with good control of bleeding.
6. The layer over the muscles was stitched.

Although Ina May is a big proponent of double layer suturing for VBAC, other people are not convinced. Go beyond sources that are citing her work and you'll see that it's not usually seen as a factor in whether to VBAC.

[newmommy27]

Apricot,

thanks that was really what I was looking for....

my reading (although I have never read op notes before) lead me to believe that it was a single layer closure....

I am reading Ina May's book now and was hoping that the single layer would not preclude me from a vbac....essentially i was hoping to get some clarity before I send them off to my new doc so I could prepare myself for what he might say

-Lori

[Jane]

See, if you were here asking about single/double, I knew you were reading Ina May. It's just the natural question that arises, no?

If you get someone who is really against VBAC with single layer closure, sometimes it's just an excuse to schedule a section - like all those doctors who pay lip service to VBAC, but diagnose macrosomic babies at term and scare up a section. There are doctors that believe as Ina May does, but lots that don't. There are certainly been ruptures with the magical double layer closure. I do think it's good that they did sticth the peritoneum and facia. It's optional, it heals just fine without it, but it's a sign of a doctor who is trying to prevent adhesions and doing the extra minutes of work. It doesn't always work...so much is hereditary.

[momileigh]

In a lot of operative reports they aren't as specific as yours and you can't even tell if there was a double layer or a single by reading it. Because of this, and due to Ina May's ideas, there are VBAC bans that didn't need to happen. We do tons of VBACs where I study and we don't care how many layers there are.