Startseite Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
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Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae

  • Clarel Antoine EMAIL logo , Jameshisa S. Alexander , Yasaman C. Yaghoubian und Joyce M. Harary
Veröffentlicht/Copyright: 11. Mai 2022
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 50 Heft 8

Abstract

Objectives

To assess the diversity of uterine closure techniques (UCTs) among providers in one institution and evaluate concurrent consideration of adverse outcomes for patient counseling, provisional care, and prevention.

Methods

Forty-four obstetricians at NYU Langone Health were emailed a survey of their uterine closure technique, patient counseling, and practice experience. Results were stratified by years of practice: ≤5, 5–20, and 20–40 years.

Results

Thirty-nine obstetricians (88.6%) completed the survey. Among those, a blunt uterine opening was preferred by 29 (74.4%), and a mid-lower segment location was favored by 34 (87.2%). At uterine closure, the endometrium was included by 20 (51.3%), with half a centimeter or more incorporated in the myometrial closure, whereas 15 (38.5%) did not factor in the endometrium’s presence. Closure duration varied from 1 to 20 min, with 21 (53.9%) lasting 1–5 min and 12 (30.8%) lasting 5–10 min. All physicians were familiar with the potential post-cesarean complications and counseled their patients accordingly; 25 (64.1%) at the first post-op visit while 14 (35.9%) did so before the next conception. Practitioners with fewer years in practice endorsed the safety of up to five consecutive cesarean births, while those with more experience approved up to ten. Thirty-two obstetricians (82.1%) stated that the risk of abnormal placentation is exclusively associated with the number of cesarean sections, whereas five (12.8%) senior obstetricians asserted that individual surgical techniques are most impactful.

Conclusions

The survey illustrates that various UCTs are performed irrespective of potential adverse sequelae and without consideration for subsequent patient counseling and care. Ongoing research must study the impact of UCT on scar healing to formulate preventive strategies for post-cesarean complications.

Keywords: cesarean scar defect; double layer uterine closure; endometrium-free uterine closure; niche; single layer uterine closure; uterine incision closure
Corresponding author: Clarel Antoine, MD, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, 302 East 30th Street, Ground Floor, 10016 New York, USA, Phone: 212 826 3300, E-mail:

Acknowledgments

The authors thank Dr. Erinn M. Hade for her statistical analysis and contribution to the final article. Erinn M. Hade, PhD: Associate Professor, Department of Population Health, Division of Biostatistics, New York University Grossman School of Medicine, New York, New York, USA.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board approved the study.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0485).

Videoclip 1: Single-layer uterine closure technique.

Received: 2021-09-20
Accepted: 2022-04-07
Published Online: 2022-05-11
Published in Print: 2022-10-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. WAPM Guideline
  3. Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
  4. Original Articles – Obstetrics
  5. Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
  6. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
  7. Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
  8. Termination of pregnancy in the second trimester – the course of different therapy regimens
  9. Hyponatremia among preeclampsia patients – a potential sign of severity
  10. Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
  11. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
  12. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
  13. The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
  14. Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
  15. Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
  16. Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
  17. Research progress on N6-methyladenosine in the human placenta
  18. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
  19. Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
  20. Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
  21. Original Articles – Fetus
  22. Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
https://doi.org/10.1515/jpm-2021-0485
Schlagwörter für diesen Artikel
cesarean scar defect; double layer uterine closure; endometrium-free uterine closure; niche; single layer uterine closure; uterine incision closure

Artikel in diesem Heft

  1. Frontmatter
  2. WAPM Guideline
  3. Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
  4. Original Articles – Obstetrics
  5. Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
  6. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
  7. Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
  8. Termination of pregnancy in the second trimester – the course of different therapy regimens
  9. Hyponatremia among preeclampsia patients – a potential sign of severity
  10. Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
  11. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
  12. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
  13. The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
  14. Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
  15. Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
  16. Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
  17. Research progress on N6-methyladenosine in the human placenta
  18. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
  19. Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
  20. Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
  21. Original Articles – Fetus
  22. Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
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