OBJECTIVE: To assess associations of a commercially available carboxymethylcellulose adhesion barrier placed during primary cesarean delivery with clinical outcomes of repeat cesarean deliveries.
METHODS: We performed a retrospective cohort study of women undergoing primary cesarean delivery on or after January 1, 2008, and first repeat cesarean delivery in one of four hospitals in the same system by June 30, 2011. Women were included if both deliveries were live singletons at 34-42 weeks of gestation delivered through transverse abdominal incisions and the first hysterotomy was low transverse. Exclusion criteria included intervening delivery; puerperal infection, bowel injury, or bladder injury at primary cesarean delivery; uterine incision or laparotomy (except primary cesarean delivery) before repeat cesarean delivery; and use of another adhesion barrier at primary cesarean delivery. As a surrogate for adhesion grading, the primary outcome was time from skin incision to neonate delivery at repeat cesarean delivery. We also assessed total operative time and rates of selected surgical complications.
RESULTS: There were 517 women who met criteria; 248 received the adhesion barrier during primary cesarean delivery and 269 did not. There were no demographic differences between groups except delivery hospital. In the adhesion barrier and no adhesion barrier groups, respectively, mean±standard deviation times to delivery at repeat cesarean delivery were 6.1±3.0 compared with 5.8±2.5 minutes (P=.25), and total operative times were 31.2±10.6 compared with 31.8±11.6 minutes (P=.56). Surgical complications were not different between groups.
CONCLUSION: Placing a commercially available carboxymethylcellulose adhesion barrier at primary cesarean delivery is not associated with decreased time to delivery, total operative time, or complications during repeat cesarean deliveries.
LEVEL OF EVIDENCE: II.
OBIETTIVO: Per valutare l'efficacia di una barriera aderenza assorbibile utilizzata al momento del parto cesareo.
STUDIO: Abbiamo condotto uno, due bracci di coorte, revisione retrospettiva della prima ripetizione tagli cesarei primari e successive dal 1 ° gennaio 2006 al 31 dicembre 2009. Criteri di esclusione sono stati rapporto operativo incomplete, storia della chirurgia addominale-pelvica prima, malattia infiammatoria pelvica, corionamniosite, il parto cesareo di emergenza o l'uso di corticosteroidi entro 2 settimane. Adesione incidenza / severità e incisione cutanea per i tempi di consegna appena nati sono stati analizzati. Sono stati esaminati gli effetti dei tipi di chiusura e di sutura peritoneali.
RISULTATI: Dei 262 cesareans primarie eseguite, il 43% (n = 112) ha avuto il taglio cesareo ripetizione. Con barriera, il 74% non ha avuto adesioni a un intervento chirurgico di ripetizione, contro il 22% nel gruppo senza barriere (p = 0,011). Undici per cento aveva grado 2 aderenze con barriera, mentre il 64% aveva grado 2-3 nel gruppo barriera (p = 0.012). Il gruppo non ha avuto barriera di grado 3 adesioni. Quelli con parietale chiusura peritoneale aveva meno incidenza (p = 0,02) e media aderenza all'importanza (p = 0,03); nessuna differenza significativa è stata trovata per tipo di sutura. Nessuna differenza statistica nel tempo da incisione cutanea alla consegna neonato è stata osservata tra il gruppo primario e la barriera (p = 0,006); quelli senza barriere avevano un intervallo di consegna statisticamente più (p = 0,35).
CONCLUSIONE: L'uso di una adesione assorbibile baóóórrier riduce l'incidenza e la gravità delle adesioni a cesareo.
To assess associations of a commercially available carboxymethylcellulose adhesion barrier placed during primary cesarean delivery with clinical outcomes of repeat cesarean deliveries.
METHODS:
We performed a retrospective cohort study of women undergoing primary cesarean delivery on or after January 1, 2008, and first repeat cesarean delivery in one of four hospitals in the same system by June 30, 2011. Women were included if both deliveries were live singletons at 34-42 weeks of gestation delivered through transverse abdominal incisions and the first hysterotomy was low transverse. Exclusion criteria included intervening delivery; puerperal infection, bowel injury, or bladder injury at primary cesarean delivery; uterine incision or laparotomy (except primary cesarean delivery) before repeat cesarean delivery; and use of another adhesion barrier at primary cesarean delivery. As a surrogate for adhesion grading, the primary outcome was time from skin incision to neonate delivery at repeat cesarean delivery. We also assessed total operative time and rates of selected surgical complications.
RESULTS:
There were 517 women who met criteria; 248 received the adhesion barrier during primary cesarean delivery and 269 did not. There were no demographic differences between groups except delivery hospital. In the adhesion barrier and no adhesion barrier groups, respectively, mean±standard deviation times to delivery at repeat cesarean delivery were 6.1±3.0 compared with 5.8±2.5 minutes (P=.25), and total operative times were 31.2±10.6 compared with 31.8±11.6 minutes (P=.56). Surgical complications were not different between groups.
CONCLUSION:
Placing a commercially available carboxymethylcellulose adhesion barrier at primary cesarean delivery is not associated with decreased time to delivery, total operative time, or complications during repeat cesarean deliveries.
