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The most typical method used for closing the uterus after a cesarean supply causes so many long-term issues that it is time to query its use. That is the conclusion reached by two world-renowned specialists in obstetrics and gynecology in an article revealed in a particular difficulty of the American Journal of Obstetrics & Gynecology on cesarean supply. The authors argue in favor of changing the present strategy with a closure method that respects the pure anatomical construction of the uterus.
The authors, Dr. Emmanuel Bujold, professor at Université Laval’s School of Drugs and researcher on the CHU de Québec-Université Laval Analysis Heart, and Dr. Roberto Romero, Head of the Being pregnant Analysis Department on the NICHD/Nationwide Institutes of Well being within the US, record the numerous long-term issues related to cesarean supply and their incidence in accordance with an exhaustive assessment of the scientific literature on the subject.
Issues which will come up throughout subsequent deliveries embody irregular attachment of the placenta to the uterus (as much as 6% of girls), which will increase the chance of extreme hemorrhage and hysterectomy; uterine rupture (as much as 3%), which might result in the loss of life of the new child; and prematurity (as much as 28%). Girls’s well being can be impacted due to pelvic ache (as much as 35%), postmenstrual bleeding (as much as 33%), and endometriosis/adenomyosis (as much as 43%).
The method used for the previous 50 years to shut the uterus after a cesarean supply includes sutures that cross by way of and be part of the uterine lining and the muscular tissues surrounding it, explains Professor Bujold. “This methodology has the benefit of being easy and fast, which limits bleeding within the mom. That is undoubtedly why it has been broadly adopted by obstetrician-gynecologists.
“However, the scar tissue produced by this type of closure does not restore the anatomical and functional integrity of the uterus, notes the scientist. When you stop to think about it, it’s not surprising. For example, when someone has a laceration on their cheek, you don’t close it by suturing the oral mucosa, muscles, and skin together. There’s no reason to do that with the uterus.”
The closure method proposed by Drs. Bujold and Romero consists of suturing collectively tissues of the identical sort. The muscle layer of the uterus is sutured in two locations, with one suture within the higher half and the opposite within the decrease half. A 3rd suture is made to shut the envelope surrounding the organ. “We do not operate on the uterine lining so as not to interfere with its natural regeneration,” explains Bujold.
Globally, one youngster is born by cesarean each second, the researcher factors out. In Canada, roughly 27% of youngsters are born by cesarean, almost double the speed noticed three many years in the past.
“Given the high frequency of cesarean and their long-term health consequences for women, finding solutions should be considered a public health priority,” says Bujold.
The drawback of the strategy really helpful by Bujold and Romero is that it takes a bit of longer. “The standard closure technique takes between two and three minutes, while the one we propose takes five to eight minutes. The resulting additional blood loss is marginal. Our position is that meticulous and adequate restoration of the uterine structure is more important than the speed of the procedure. The future reproductive health of women who undergo cesarean must be the priority,” concludes the researcher.
Extra info:
Emmanuel Bujold et al, Uterine closure after cesarean supply: surgical rules, organic rationale, and scientific implications, American Journal of Obstetrics and Gynecology (2025). DOI: 10.1016/j.ajog.2025.10.007
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Frequent cesarean closure methodology linked to long-term issues, consultants counsel change (2025, November 14)
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