Do Different Surgical C-Section Techniques Affect Outcomes?
This study by the Coronis Collaborative Group (Lancet, 2016) aimed to determine if there were differences in maternal morbidity depending on which of five surgical techniques for caesarean section a woman received.
Randomized Control Trial
13,153 women were followed up with for a mean duration of 3.8 years after receiving a C-section through one of five surgical techniques. The five pairs of alternative surgical techniques surveyed were blunt vs. sharp abdominal entry; exteriorization of the uterus vs. intra-abdominal repair; single vs. double layer closure of the uterus; closure vs. non-closure of the peritoneum; and chromic catgut vs. polyglactin-910 sutures.
The study found no evidence to prefer one surgical technique over another based on the following outcomes
Blunt vs sharp abdominal entry
Abdominal hernias: no difference (adjusted relative risk 0·66; 95% CI 0·39–1·11)
Exteriorization vs abdominal repair
Infertility: no difference (adjusted relative risk 0·91, 0·71–1·18)
Ectopic pregnancy: no difference (adjusted relative risk 0·50, 0·15–1·66)
Single vs double uterine closure
Maternal death: no difference (adjusted relative risk 0·78, 0·46–1·32)
Composite of pregnancy complications (adjusted relative risk 1·20, 0·75–1·90)
Peritoneal closure vs non-closure
Pelvic adhesions (related complications such as infertility): no difference (adjusted relative risk 0·80, 0·61–1·06)
Chromic catgut vs polyglactin-910 sutures
Adverse pregnancy outcomes in a subsequent pregnancy, such as uterine rupture: no difference (adjusted relative risk 3·05, 0·32–29·29).
Overall, severe adverse outcomes were uncommon in these settings
Determination of technique will take in to account other factors including time and cost
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