PubMed · 15423770
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S BENDER. 1950-06-09. Caesarean section.. https://pubmed.ncbi.nlm.nih.gov/15423770/
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The strongest argument against caesarean delivery relates to maternal complications. Evidence supporting this for elective operations is controversial. The perinatal database 1998-2001 of the German state of Baden-Württemberg was studied to assess the maternal obstetrical risk associated with caesarean delivery with regard to puerperal infectious complications. For statistical analysis the chi2 test, Fisher's exact test, Mantel-Haenszel statistics and relative risks were used to describe the risk of exposure. Surgical delivery was associated with a significantly higher risk of infectious disorders (p < 0.0001). There was a significantly higher risk of septicaemia in the group undergoing caesarean compared to vaginal delivery (p < 0.0001), for pregnancies with and without risk factors of infection, and also for caesarean delivery prior to labour and rupture of membranes (ROM) and singleton gestations (RR 8.56; 95% CI 4.4-16.65, stratum without risks). The rate of wound disorders was found to be significantly increased in the case of surgical delivery (p < 0.0001). After exclusion of pregnancies with risk factors for infectious complications and multi-fetal gestation, a significantly higher risk was also found for caesarean delivery prior to labour and ROM versus vaginal delivery (RR 16.97; 95% CI 14.16-20.34). Caesarean delivery significantly increased the likelihood that a woman would experience fever in puerperium (p < 0.0001), for pregnancies with and without ante- or perinatal risk factors for infectious complications, and also when caesarean delivery prior to labour and ROM and singletons in the cephalic presentation were considered separately (RR 11.03; 95% CI 9.39-12.96; stratum without risks). Considering the obstetrical challenge of how more women can deliver with fewer complications, reducing unnecessary caesarean delivery still seems to be an appropriate approach.
OBJECTIVE: To find out whether a change in suturing technique might affect the healing of the uterine scar after caesarean section (CS). STUDY DESIGN: In this randomised prospective study, 78 term pregnant patients delivered by CS were allocated to two different suturing techniques either including or excluding the endometrial layer. The integrity of the uterine incision was checked by ultrasound 40-42 days after the operation. Any deviation from the full thickness apposition of the anterior uterine wall (with the ratio: [anterior wall thickness/(anterior wall thickness+height of the wedge shaped defect)]<1) was considered to represent incomplete healing. Both groups were then compared in terms of the frequency of incomplete healing. Chi square and Student's t-test were used where appropriate. A logistic regression model was used to adjust for confounding factors. RESULTS: The frequency of incomplete healing was significantly lower in the group treated by full thickness suturing (44.7% versus 68.8%); (OR: 2.718; CI: 1.016-7.268). Similarly the mean values for the incomplete healing ratio were 0.77+/-0.17 and 0.86+/-0.17 (p = 0.03) in split and full thickness groups, respectively. After adjusting for other confounding factors the suture technique still remained as a significant determinant of the incisional healing (p = 0.04). CONCLUSION: By selecting full thickness suturing technique one may significantly lower the incidence of incomplete healing of the uterine incision after CS.
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