Surgical Techniques at Cesarean Delivery: A U.S. Survey

Area of Science:

• Obstetrics and Gynecology
• Surgical Techniques
• Patient Safety

Background:

• Cesarean delivery (CD) is a common surgical procedure.
• Standardization of surgical techniques in CD is an area of ongoing research.
• Variations in surgical practices may impact patient outcomes.

Purpose of the Study:

• To determine the frequency of different surgical closure techniques used during cesarean delivery by U.S. obstetricians.
• To identify factors influencing the adoption of specific surgical techniques.

Main Methods:

• A survey was e-mailed to a random sample of American College of Obstetrician Gynecologists members.
• The survey assessed surgical closure techniques, surgeon demographics, and reasons for technique selection.
• Data were analyzed using descriptive statistics and analysis of variance.

Main Results:

• The response rate was 53% (247 surveys analyzed).
• Similar proportions of obstetricians "always or usually" versus "rarely or never" reapproximate rectus muscles (38.4% vs. 43.3%) and close parietal peritoneum (42.5% vs. 46.9%).
• Double-layer hysterotomy closure (73.3%) and skin suturing (67.6%) were most frequent; visceral peritoneum closure was least frequent (12.2%).
• Surgeons performing double-layer hysterotomy closure had fewer years in practice (p=0.021); those closing visceral peritoneum were older with more years in practice (p<0.001).

Conclusions:

• Significant variation exists in U.S. obstetricians' practices regarding rectus muscle and parietal peritoneum closure during cesarean delivery.
• Surgeon demographics, such as years in practice and age, are associated with specific surgical techniques.
• Safety concerns and surgeon experience likely influence the choice of cesarean delivery surgical methods.