Presenter : dr.

Jamatul Firdaus
Moderator : dr. H. Nuswil Bernolian, SpOG(K)


Fetomaternal Division
Journal Reading

US SC rate : 5% (1970) 33%(2010)
90% having repeat C-Section

Adhesions as results of prior C-Section
cause delayed delivery

Delayed of incision till delivered the neonates
affect negatively for newborns especially
in urgent or emergency cases, also
increase maternal complications






SEPRAFILM
(Sodium
Hyaluronate
& CMC)
An
Adjunct
To reduce
of adhesion
formation
Study
SEPRAFILM
uses are
limited

Ideal study
evaluate
CMC uses &
outcomes of
repeat
c-section




A Retrospective Cohort Study
Primary C-Section
01.01.2008 Repeat C-
Section by 30 June 2011 4
Hospitals
The institutional review board of
Banner Good Samaritan Medical Center
(Phoenix, Arizona) approved the study


Both deliveries
SLF at 3442
weeks of
gestation,
Delivered through
transverse
abdominal
incisions
1
st
hysterotomy
was low
transverse
Inclusion
Criteria


having an intervening delivery
Immune dysfunction
puerperal infection,
bowel injury, or bladder injury
at the time of primary cesarean
delivery;
PID
Uterine incision (eg,
myomectomy), or laparotomy
(except the primary cesarean)
before the repeat cesarean
delivery;
systemic steroids (except for
fetal benefit) within 6 months
before either cesarean delivery
use of another adhesion barrier
at the time of primary cesarean
delivery
Exclusion
Criteria

Time from skin incision
to neonate delivery at
repeat cesarean
delivery
Primary
Outcomes
Total operative time during repeat cesarean delivery
Estimated blood loss
Rates of complications related to the repeat SC
delivery (estimated blood loss, endometritis, wound
abscess, wound cellulitis, pelvic abscess, urinary
infection, hospital readmission, & reoperation)
Immediate neonatal complications (eg, 5 A/S <7)
Secondary
Outcomes


Used SPSS 21.0 to analyses datas

Students t test analyzed Continuous variables

X
2
or Fishers exact test analyzed Categorical
variables
Linear regression used to evaluate factors
affecting the incision to delivery time at repeat
cesarean delivery
Logistic regression to evaluate
independent predictors of adhesions at repeat
cesarean delivery

P value < 0.01 considered statistically significant
Placing CMC at primary SC NOT
associated with decrease in time
to neonate delivery during repeat
c-section

Use Of CMC NOT associated with
any improvement of either
adhesiond in general or
significant adhesions
Study limitations :
Didnt anticipate finding an
association between obesity and
adhesion

Rates of postpartum complications

Differenciations in surgical technique
Study Strength :
Large sample in the same hospital
system

Designed of criteria

> 100 Obstetricians performed
CMC use NO ASSOCIATION :
Time to neonate delivery at repeat
C-Section

Decrease in total operative time

Operative complications
CMC :

No beneficial use
for primary C-
Section

Expensive ($ 493)