PMID- 35538677
OWN - NLM
STAT- MEDLINE
DCOM- 20220930
LR  - 20230922
IS  - 1619-3997 (Electronic)
IS  - 0300-5577 (Linking)
VI  - 50
IP  - 8
DP  - 2022 Oct 26
TI  - Variations in uterine closure technique: an institutional survey of obstetricians 
      and implications for patient counseling and prevention of adverse sequelae.
PG  - 1045-1052
LID - 10.1515/jpm-2021-0485 [doi]
AB  - OBJECTIVES: To assess the diversity of uterine closure techniques (UCTs) among 
      providers in one institution and evaluate concurrent consideration of adverse 
      outcomes for patient counseling, provisional care, and prevention. METHODS: 
      Forty-four obstetricians at NYU Langone Health were emailed a survey of their 
      uterine closure technique, patient counseling, and practice experience. Results 
      were stratified by years of practice: </=5, 5-20, and 20-40 years. RESULTS: 
      Thirty-nine obstetricians (88.6%) completed the survey. Among those, a blunt 
      uterine opening was preferred by 29 (74.4%), and a mid-lower segment location was 
      favored by 34 (87.2%). At uterine closure, the endometrium was included by 20 
      (51.3%), with half a centimeter or more incorporated in the myometrial closure, 
      whereas 15 (38.5%) did not factor in the endometrium's presence. Closure duration 
      varied from 1 to 20 min, with 21 (53.9%) lasting 1-5 min and 12 (30.8%) lasting 
      5-10 min. All physicians were familiar with the potential post-cesarean 
      complications and counseled their patients accordingly; 25 (64.1%) at the first 
      post-op visit while 14 (35.9%) did so before the next conception. Practitioners 
      with fewer years in practice endorsed the safety of up to five consecutive 
      cesarean births, while those with more experience approved up to ten. Thirty-two 
      obstetricians (82.1%) stated that the risk of abnormal placentation is 
      exclusively associated with the number of cesarean sections, whereas five (12.8%) 
      senior obstetricians asserted that individual surgical techniques are most 
      impactful. CONCLUSIONS: The survey illustrates that various UCTs are performed 
      irrespective of potential adverse sequelae and without consideration for 
      subsequent patient counseling and care. Ongoing research must study the impact of 
      UCT on scar healing to formulate preventive strategies for post-cesarean 
      complications.
CI  - (c) 2022 Walter de Gruyter GmbH, Berlin/Boston.
FAU - Antoine, Clarel
AU  - Antoine C
AD  - Department of Obstetrics and Gynecology, New York University Grossman School of 
      Medicine, New York, NY, USA.
FAU - Alexander, Jameshisa S
AU  - Alexander JS
AD  - Compassionate Ob/Gyn Care PLLC, New York, NY, USA.
FAU - Yaghoubian, Yasaman C
AU  - Yaghoubian YC
AD  - Department of Obstetrics and Gynecology, North Shore University Hospital/Long 
      Island Jewish Medical, New York, NY, USA.
FAU - Harary, Joyce M
AU  - Harary JM
AD  - Icahn School of Medicine at Mount Sinai, NY, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20220511
PL  - Germany
TA  - J Perinat Med
JT  - Journal of perinatal medicine
JID - 0361031
SB  - IM
MH  - Cicatrix/etiology
MH  - Counseling
MH  - Female
MH  - Humans
MH  - *Physicians
MH  - Pregnancy
MH  - *Suture Techniques/adverse effects
MH  - Uterus/pathology/surgery
OTO - NOTNLM
OT  - cesarean scar defect
OT  - double layer uterine closure
OT  - endometrium-free uterine closure
OT  - niche
OT  - single layer uterine closure
OT  - uterine incision closure
EDAT- 2022/05/12 06:00
MHDA- 2022/10/01 06:00
CRDT- 2022/05/11 02:02
PHST- 2021/09/20 00:00 [received]
PHST- 2022/04/07 00:00 [accepted]
PHST- 2022/05/12 06:00 [pubmed]
PHST- 2022/10/01 06:00 [medline]
PHST- 2022/05/11 02:02 [entrez]
AID - jpm-2021-0485 [pii]
AID - 10.1515/jpm-2021-0485 [doi]
PST - epublish
SO  - J Perinat Med. 2022 May 11;50(8):1045-1052. doi: 10.1515/jpm-2021-0485. Print 
      2022 Oct 26.