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Grand Rounds

Do Different Surgical C-Section Techniques Affect Outcomes?

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PURPOSE:

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.

METHODS:

Randomized Control Trial

RESULTS:

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).

CONCLUSIONS:

  • Overall, severe adverse outcomes were uncommon in these settings
  • Determination of technique will take in to account other factors including time and cost

Learn More – Primary Sources:

Caesarean section surgical techniques: 3 year follow-up of the CORONIS fractional, factorial, unmasked, randomised controlled trial

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

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What is the best skin prep to prevent C-section wound infections?
Practical info on evidence based medicine for your women's healthcare practice
Is it better to leave the uterus in the abdominal cavity or exteriorize it following C-section?
C-Section Skin Closure: Glue or Subcuticular Sutures?
Single or Double-Layer Closure at C-Section and Resulting Uterine Thickness

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