Double-layered purse string uterine suture compared with single-layer continuous uterine suture: A randomized Controlled trial.

BACKGROUND: With the aim of preventing cesarean scar defects, we introduced a new technique involving a purse string uterine suture. To date, this uterine suture technique has not been formally evaluated. The objective of the study was to test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. METHODS: A prospective randomized study. Primary outcome was the rate of CSD. 100 patients were enrolled in 2 groups according to the uterine suture technique. A hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery .Operative time and calculated blood loss (CBL) were used for the short time analysis. Uterine and CSD measurements were used for the mid time analysis. RESULTS: Despite a longer operative time with PSUS (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 with PSUS vs. 536 ± 50 ml, p = 0.724). There was a significant decrease in the rate of CSD with PSUS: 6.66% Vs.40% with SLUCS; p<0.001. Moreover, SLUCS was the leading risk factor for CSD: adjusted OR=6; 95% CI [0-1], p<10‾³). CONCLUSION: Compared to single layer continuous suture, double layered purse stringuterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity.

The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial.

OBJECTIVE: To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. STUDY DESIGN: One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. RESULTS: Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04-2.41] vs. 2.93 [2.46-3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. CONCLUSIONS: Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.

French ambulatory cesarean: Mother and newborn safety.

OBJECTIVE: To evaluate mother and newborn child safety after French ambulatory cesarean (FAUCS). METHODS: Prospective comparative cohort study in Tunisia (January-June 2018). Pregnant women indicated for primary or repeat cesarean at term underwent FAUCS or Misgav Ladach cesarean (MLC). Surgical outcomes, overall morbidity, and maternal autonomy during recovery were compared. RESULTS: Among 112 deliveries, 60 were performed by FAUCS and 52 by MLC. FAUCS was feasible in all cases; surgeons achieved a completely extraperitoneal approach in 39 (65.0%) cases. The main difficulty experienced was fetal extraction. Longer operative procedures were recorded in the FAUCS group; however, women in the FAUCS group reported lower pain scores (3 [2-5] vs 4 [3.7-5], P<0.001) and were more likely to decline analgesics (10 [17.0%] vs 0 [0%], P<0.001). They experienced greater autonomy during recovery (median [interquartile range] time to standing, 2 [1.0-2.5] vs 12.8 [8.9-17.9] hours, P<0.001; time to full meal, 4 [3-6[ vs 26.5 [21-31] hours, P<0.001; effective time to hospital discharge, 1 [1, 2] vs 2 [2, 3] days; P<0.001). CONCLUSION: Implementation of the FAUCS technique was safe and successful, and improved maternal condition after cesarean. These short-term results need long-term validation by randomized trials.

Effects of maternal retinoic acid administration in a congenital diaphragmatic hernia rabbit model.

Maternal retinoid administration has beneficial effects on lung development in the nitrofen rodent toxic model of congenital diaphragmatic hernia (DH). We wanted to investigate the effects in a surgical model, where the retinoid signaling pathway is not primarily disrupted by the toxic agent. We created DH in fetal rabbits at day 23 of gestation, administrated to the does all trans-retinoic acid (ATRA) or vehicle (VHC) intramuscularly for 8 consecutive days and harvested normal and operated (DH) fetuses at 31 d (n = 7 in each group). Normal lungs exposed to ATRA had increased surfactant protein mRNA levels without change in type II pneumocyte density. There was no measurable effect on lung-to-body weight ratio and airway morphometry by ATRA. In DH lungs (DH/VHC) surfactant protein mRNA levels were increased, as well as the density of type II pneumocytes. When supplemented with ATRA (DH/ATRA) these parameters returned to normal (VHC). Cell proliferation or apoptosis were not influenced by ATRA supplementation. In conclusion, maternal ATRA supplementation does not affect gross anatomic, morphologic or proliferation indices in hypoplastic lungs related to surgically induced DH in rabbit. However, ATRA lowers surfactant protein expression and normalizes type I/II pneumocyte ratio to what is observed in normal lungs.