Surgical Techniques for Cesarean Delivery: Free Rein?

Summary and Comment |
May 25, 2016

Surgical Techniques for Cesarean Delivery: Free Rein?

  1. Allison Bryant, MD, MPH

Among several techniques, long-term health outcomes did not differ.

  1. Allison Bryant, MD, MPH

As cesarean delivery is the most common major inpatient surgery in the U.S. (with up to 1 million procedures performed annually), the consequences of even small differences in morbidity associated with particular surgical techniques would be magnified across the population. Investigators for the CORONIS study — an international trial in which women undergoing lower-segment cesarean were randomized to various surgical techniques — now report longer-term outcomes.

Of the original 15,633 participants, 13,153 (84%) were followed up at least 3 years after surgery (mean, 3.8 years). Only 44% had subsequent pregnancies during follow-up, substantially lower than expected. In the original study, women were randomized to blunt or sharp abdominal entry, exterior or intra-abdominal hysterotomy repair, double- or single-layer uterine closure, closure of the peritoneum or not, and chromic catgut or polyglactin suture for uterine closure. None of the study outcomes (pelvic pain, dysmenorrhea, hernia, need for subsequent surgical procedures including hysterectomy, infertility, and outcomes of later pregnancies) varied by surgical technique.

Comment

As a surgeon, I find it reassuring that my training and experience in specific cesarean techniques including exterior uterine repair are unlikely to be associated with short- or long-term harm to my patients. Still, health outcomes are not the only meaningful results as we work within the broader context of the healthcare system. Given the high prevalence of cesarean delivery, even small differences in operating room time or cost associated with particular techniques will also be amplified; thus, we must strive to optimize efficiency in these domains. Also, while the authors raised concern about the lower-than-expected repeat pregnancy rates in the study population, I wonder whether stronger global messaging about appropriate birth spacing might be at least partially responsible.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

TAPAS GOSWAMI Other Healthcare Professional, Obstetrics/Gynecology, PRIVATE CLINIC

IN AN EARLIER TRIAL, IT WAS FOUND THAT THERE WERE MORE SCAR DEHISCENCE / RUPTURE IN SUBSEQUENT PREGNANCIES.

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