Rethinking Cesarean Closure Techniques For Better Long-term Health

The astir communal method utilized for closing nan uterus aft a cesarean transportation causes truthful galore semipermanent complications that it's clip to mobility its use. That's nan conclusion reached by 2 world-renowned specialists successful obstetrics and gynecology successful an article published successful a typical rumor of nan American Journal of Obstetrics & Gynecology connected cesarean delivery. The authors reason successful favour of replacing nan existent attack pinch a closure method that respects nan earthy anatomical building of nan uterus.

The authors, Dr. Emmanuel Bujold, professor astatine Université Laval's Faculty of Medicine and interrogator astatine nan CHU de Québec-Université Laval Research Center, and Dr Roberto Romero, Head of nan Pregnancy Research Branch astatine nan NICHD/National Institutes of Health successful US, database nan galore semipermanent complications associated pinch cesarean transportation and their incidence according to an exhaustive reappraisal of nan technological lit connected nan topic.

Complications that whitethorn originate during consequent deliveries see abnormal attachment of nan placenta to nan uterus (up to 6% of women), which increases nan consequence of terrible hemorrhage and hysterectomy; uterine rupture (up to 3%), which tin lead to nan decease of nan newborn; and prematurity (up to 28%). Women's wellness tin besides beryllium impacted because of pelvic symptom (up to 35%), postmenstrual bleeding (up to 33%), and endometriosis/adenomyosis (up to 43%).

The method utilized for nan past 50 years to adjacent nan uterus aft a cesarean transportation involves sutures that walk done and subordinate nan uterine lining and nan muscles surrounding it, explains Professor Bujold. "This method has nan advantage of being elemental and quick, which limits bleeding successful nan mother. This is undoubtedly why it has been wide adopted by obstetrician-gynecologists. However, nan scar insubstantial produced by this type of closure does not reconstruct nan anatomical and functional integrity of nan uterus, notes nan scientist. When you extremity to deliberation astir it, it's not surprising. For example, erstwhile personification has a laceration connected their cheek, you don't adjacent it by suturing nan oral mucosa, muscles, and tegument together. There's nary logic to do that pinch nan uterus."

The closure method projected by Drs Bujold and Romero consists of suturing together tissues of nan aforesaid type. The musculus furniture of nan uterus is sutured successful 2 places, pinch 1 suture successful nan precocious portion and nan different successful nan little part. A 3rd suture is made to adjacent nan letter cover surrounding nan organ. "We do not run connected nan uterine lining truthful arsenic not to interfere pinch its earthy regeneration," explains Bujold.

Globally, 1 kid is calved by cesarean each second, nan interrogator points out. In Canada, astir 27% of children are calved by cesarean, astir double nan complaint observed 3 decades ago. "Given nan precocious wave of cesarean and their semipermanent wellness consequences for women, uncovering solutions should beryllium considered a nationalist wellness priority," says Bujold.

The disadvantage of nan attack recommended by Bujold and Romero is that it takes a small longer. "The modular closure method takes betwixt 2 and 3 minutes, while nan 1 we propose takes 5 to 8 minutes. The resulting further humor nonaccomplishment is marginal. Our position is that meticulous and capable restoration of nan uterine building is much important than nan velocity of nan procedure. The early reproductive wellness of women who acquisition cesarean must beryllium nan priority," concludes nan researcher.