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
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan