Diathermy versus scalpel in transverse abdominal incision in women undergoing repeated cesarean section: A randomized controlled trial.

AIM: The aim of this study was to evaluate the volume of blood loss, wound incision time and wound complication according to use of scalpel or electrosurgery during the creation of transverse abdominal incisions during repeated cesarean section (CS). MATERIAL AND METHODS: A randomized controlled trial was carried out at Ain Shams University Maternity Hospital. We recruited 130 women with a history of one previous CS at the time of their planned lower-segment CS. Participants were randomized to anterior abdominal wall opening from subcutaneous tissue till the peritoneum by either the use of scalpel with disposable blade (No. 22) or diathermy using the standard diathermy pen electrode. The main outcome measures were the volume of blood loss from skin incision to the end of the peritoneal incision, the operative time and wound complication. RESULTS: We observed a highly significant difference between the two groups in blood loss (median [interquartile range], 11 [8-15.25] g for the diathermy group vs 20 [18-23] g for the scalpel group, P < 0.001) and skin-to-peritoneum incision time (median [interquartile range], 7 [5-7.25] min for the diathermy group vs 10 [7-11] min for the scalpel group, P < 0.001). The postoperative pain was less in the diathermy group but wound complications showed no statistical difference. CONCLUSION: The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time but has no impact on postoperative pain or wound complications.

Adhesion prevention in patients with multiple cesarean deliveries.

Adhesion formation is a well-known complication of abdominal surgery. Although one third of all deliveries in the United States are by cesarean delivery (CD), little is known about adhesions in the obstetric setting. Various surgical techniques for reducing adhesion formation following CD have been investigated. The relative benefits of peritoneal closure and single-layer uterine closure are areas of continued research and debate. Adhesion prevention products are also becoming more commonplace in gynecologic surgery. Two membrane/adhesion barriers have been approved in the United States. A barrier consisting of oxidized regenerated cellulose (Interceed absorbable adhesion barrier) has been shown to reduce adhesions during microsurgery. Its use may be limited following CD because complete hemostasis is crucial to its efficacy. Seprafilm adhesion barrier, composed of hyaluronic acid and carboxymethylcellulose, is approved for use in abdominal or pelvic laparotomy. Preliminary data suggest that it may be effective for reducing adhesions following CD. This article discusses what is currently known about adhesion prevention in the obstetric population and highlights the paucity of level I evidence available to clinicians in this setting.

Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment.

OBJECTIVE: To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section. STUDY DESIGN: A randomized double blinded trial. PLACE AND DURATION OF STUDY: Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010. METHODOLOGY: Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p < 0.05. RESULTS: In only 2 (6.6%) of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 (53%) of one layer closure group, and 10 (33%) of the two layer closure group. At 6 weeks, the mean car thickness in group C (17.08 +1.635 mm) was significantly greater (p < 0.001) as compared to group A (13.19 + 1.32 mm) and group B (14.58 +1.18 mm). At long-term follow-up, only 1 (6%) case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 (23%) in group A and 2 (14%) in group B. CONCLUSION: Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section.

Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation.

The ex utero intrapartum treatment procedure allows for the controlled management of a potentially life-threatening difficult airway in the newborn. General anesthesia has previously been reported for the management of this procedure. We report the use of continuous spinal anesthesia in conjunction with intravenous nitroglycerin for the ex utero intrapartum treatment procedure in a woman with arthrogryposis multiplex congenita, a rare syndrome characterized by rigid joints and limb contractures.