Surgical techniques for uterine incision and uterine closure at the time of caesarean section

Dodd, Jodie M; Anderson, Elizabeth; Gates, Simon; Grivell, Rosalie M

doi:10.1002/14651858.cd004732.pub3

Cited by 90 publications

(95 citation statements)

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“…23 Two further trials that compared single-layer and double-layer uterine closure published since the Cochrane review was last updated have been identifi ed, involving 208 women in one 24 and 2979 women in the other. 9 None of the existing studies suggest major diff erences in short-term outcomes between single-layer and double-layer uterine closure.…”

Section: Discussionmentioning

confidence: 99%

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Ábalos¹,

et al. 2013

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SummaryBackground Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies.Methods CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined fi ve elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the fi ve intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intraabdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their fi rst or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. Interpretation These fi ndings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term eff ects will translate into an absence of long-term eff ects.Funding UK Medical Research Council and WHO.

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Section: Discussionmentioning

confidence: 99%

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Ábalos¹,

et al. 2013

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“…Sezaryen, dünya genelinde yaygın olarak yapılan bir operasyon olmasına rağmen, kabul edilebilecek en uygun cerrahi teknik için sınırlı bilgi vardır (13) .…”

Section: Discussionunclassified

“…Histerotomi insizyonun hangi şekilde kapatılması gerektiği, gelecek gebelikler sırasında uterus rüptürü ile potansiyel bir ilişki kazanmıştır (14) . Uterus rüptü-rünün, kötü obstetrik komplikasyonlarından biri, neonatal ve maternal morbiditedir (15,16) .…”

Section: Discussionunclassified

“…(18) tarafından geliştirilen "Misgav-Ladach" tekniğinin bir parçasıdır. Çift katmanlı kapatmaya zıt olarak tek katmanlı kapama çalışma süresini ve kan kaybını azaltmak açısından üstünlük sağlamıştır (14) . Ancak, çoğu randomize kontrollü çalışmada, cerrahi teknik açısından olumlu ya da olumsuz sonuçlar bulanamamış ve bu hastaların uzun dönem izlemi yapılamamıştır (19) .…”

Section: Discussionunclassified

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The Effect of Single-Layer or Double-Layer Closure of the Uterine Incision at Cesarean Section on Uterine Scar Formation

Baran¹,

Avci²,

Çakıroğlu³

et al. 2017

IKSST

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“…Copyright: ©2016 Nasr reduction of birth trauma to the infant has to be balanced against increased ill-health for the mother [9]. This is a prospective randomized controlled study performed on a total of 120 pregnant patients with one or more previous cesarean section\s.…”

Section: Inverted "T" Incision Restricted To Lower Uterine Segment Asmentioning

confidence: 99%

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2016

MOJWH

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Background: Cesarean section (CS) rates have been increasing worldwide. Many complications may arise during uterine entry in patients with previous CS due to scarring and loss of lower segment elasticity hence the need for development of a safer surgical technique.Objectives: to evaluate a new surgical technique of uterine entry during CS through elective inverted T incision in lower uterine segment (LUS) in patients with repeated cesarean section/s. Setting:Obstetrics & Gynecology Department of Al Azhar University Hospital. Patients and methods:A total of 120 term cephalic singleton pregnant women with previous cesarean section/s were randomized in to 2 groups. a) Group A: 60 patients for whom elective CS with the new technique of Inverted T lower segment CS (LSCS) was performed.b) Group B: 60 patients for whom curvilinear LSCS was performed.Results: Elective inverted T incision was associated significantly with decrease incidence of angles extension, broad ligament hematoma and injury of LUS (1.7% vs. 11.7% p =0.028), (0.0% vs. 6.7% p =0.042) and (0.0% vs. 6.7% p = 0.042) for group A & B respectively. At the start of the study it was associated significantly with increased amount of blood loss and longer duration of CS (495.7 ± 47.9 cc vs. 417.4 ± 34.9 cc, and 47.6 ± 5.5 Vs. 38.97 ± 4.1 minutes p= 0.001 for A & B respectively), however by study progression the difference become statistically insignificant (p=0.058). The new technique did not increase incision-delivery interval or fetal morbidity (p>0.05). Conclusion:Our new technique of inverted "T" incision restricted to LUS during Elective CS significantly decreased the incidence of angles extension, broad ligament hematoma and lower segment injury. It avoids upper segment and lateral extension without affection of operation time or blood loss. It is a safer technique for mother and fetus in scared LUS due to repeated CS.

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Surgical techniques for uterine incision and uterine closure at the time of caesarean section

Abstract: Caesarean section is a common procedure performed on women worldwide. There is increasing evidence that for many techniques, short-term maternal outcomes are equivalent. Until long-term health effects are known, surgeons should continue to use the techniques they prefer and currently use.

Cited by 90 publications

References 50 publications

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

The Effect of Single-Layer or Double-Layer Closure of the Uterine Incision at Cesarean Section on Uterine Scar Formation

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