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Research and Reports in Gynecology and Obstetrics | Volume 3
November 14-15, 2019 | Singapore
Obstetrics and Gynecology
4
th
International Conference on
An evidence-based cesarean section for universal use
Michael Stark
New European Surgical Academy, Germany
A
s most abdominal operations have today endoscopic
alternatives, caesarean section will certainly remain
the only abdominal operation in the future. Therefore, it is
of utmost importance to constantly evaluate its different
steps for their necessity and optimal way of performance
in order to achieve a unified evidence-based method. The
modified Joel-Cohen method results in a shorter incision to
delivery time, lower rate of febrile morbidity compared to
the traditional Pfannenstiel or longitudinal incisions. Opening
peritoneum using bi-digital repeated stretching instead of
sharp instruments proved to be safer. The uterus should be
opened in the lower segment where less muscle tissue and
more fibrous tissue is present. Exteriorization of the uterus
makes the uterine wall closing easier and reduce bleedings.
Suturing the uterus with one-layer results in stronger scar and
reduced pain. Leaving both peritoneum layers open proved
in standardized studies to reduce adhesions and result in less
need of painkillers and closure should be avoided in any other
surgical disciplines as well, including endoscopy. The fascia
being sutured continuously with first knot underneath the
fascia prevents irritation in the sub-cutis and only few sutures
should be used to close the abdomen. Since the introduction
of this modified and simplified method 30 years ago, it has
been evaluated by scores of peer-reviewed studies. With
no single exception all showed various advantages of this
method: shorter operation time, shorter hospitalization,
quicker mobiliza¬tion, less blood loss, lower rate of febrile
morbidity, lower costs, and less need for painkillers. In order
to standardize this operation, it is important to use constantly
the same suture materials, needles and instruments. A big
needle is necessary for the uterus, as fewer steps are done
which results in less foreign body reaction. The risk of overuse
of the cesarean section and possible influences on human
evolution will be addressed.
e
:
mstark@nesacademy.orgRes Rep Gynaecol Obstet, Volume:3
DOI: 10.35841/2591-7366-C3-009