Expert offers insights on C-section techniques: small improvements in surgical technique said to confer substantial benefits to maternal health.(Obstetrics)

ASHEVILLE, N.C. -- Small changes in technique can make a big difference in cesarean section outcomes, which is why it's important to keep up to date with the evidence concerning this procedure, Thomas Ivester, M.D., said at the Southern Obstetric and Gynecologic Seminar.

With an estimated 800,000-1,000,000 C-sections performed in the United States each year, "small improvements in our technique and reductions in morbidity and mortality have a profound effect on the public's health and confer substantial benefits with regard to maternal health," said Dr. Ivester, of the University of North Carolina at Chapel Hill.

Still, "for a lot of things that we do, we don't really know why we do it. I think that a lot of our specialty is governed by tradition and convention that's just been handed down over the years," said Dr. Ivester. He offered his thoughts on the existing data for a number of aspects of C-section.

Incision Type

Low transverse incisions (Pfannenstiel, Maylard, Cherney) have a far lower rate of dehiscence than do midline incisions. Good exposure is possible, especially with extension techniques. These incisions are less painful for patients. Low transverse abdominal incisions are appropriate for obese patients, who have complication rates similar to or better than those of patients receiving vertical incisions.

Cautery Use

Minimal cautery use is generally recommended; the assumption is that cauterization devitalizes tissue, hindering the angiogenesis needed for wound repair.