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

Related ObG Topics:

What is the best skin prep to prevent C-section wound infections?

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