New study favors sutures over staples for closing a C-section incision

Researchers from Thomas Jefferson University in Philadelphia believe to have settled a longstanding debate over how to close a C-section, sutures trumping staples by a whopping 57 percent decrease in wound complications. Although C-sections have become common in the developed world, accounting for a third of live births in the United States and nearly 50 percent of births in China, doctors never quite settled the debate and some say staples work better on overweight women.

'There has been ongoing debate in the field about the use of sutures versus staples,' says senior author Vincenzo Berghella, M.D., director of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology at Thomas Jefferson University. He added, 'C-sections are a common procedure in the United States, and yet we still haven't established the best way to close these incisions.' The study is the largest of its kind and researchers from three hospitals worked with 746 women who gave birth via caesarean section. (Read: 12 causes for a Caesarean section)

Researchers divided participants equally into 'stitches' and 'staples' groups, making sure overweight women were equally represented. They also ensured the mothers were equally represented concerning prior caesarean experience, eliminating the possibility of differences in results due to the aforementioned factors. Results showed 40 out of 376 women had complications with their staples, while only 18 of 370 experienced troubles after having been sutured. Incisions that had been sutured were 80 percent less likely to re-open more than 1cm than were those closed with staples. (Read: Understanding Induced labour and Caesarean sections)

The authors cite a 2013 study that, given the above data, reflects a disturbing trend of doctors preferring staples for their personal convenience such as ease of use and the nine minutes of time saved, on average. 'Based on these results, we recommend that C-section incisions be closed with stitches rather than staples,' says Dr. Berghella, who has authored several evidence-based guidelines for Obstetrics and Gynecology and is also the current president of the Society for Maternal-Fetal Medicine. Recently published in the journal Obstet-Gynacol, researchers hope their study will lead to safer choices on the part of doctors and their patients alike. (Read: How to plan for a birth without violence)

What is C-Section?

A Caesarean section is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. Doctors usually recommend C-section is cases where the baby cannot be delivered through a normal vaginal delivery. This can happen in cases when the woman has twins (or triplets etc), a breach delivery is expected (baby is descending legs first instead of the head), the baby is large, there is some problem associated with the uterus or a placenta previa is detected (the placenta is low and covers the cervix). Sometimes, during normal labour, the doctor might make the decision to proceed with a caesarean section too.

Caesareans are of two types: the preferred lower-segment caesarean section or LSCS and the older less commonly used classical section. In an LSCS, the cut on the uterus is placed at its lower end and such a cut has many advantages both during the surgery and for post-operative recovery.

On the other hand, when this area of the uterus is not accessible for some reason, the doctor may still opt for a classical section where the cut is placed on the upper part of the uterus.

The C-section is performed under the effect of an epidural or spinal anaesthesia so that you are numb from the waist down. A horizontal skin incision is made just above your 'bikini line' and the abdominal muscles are separated. Usually, a horizontal incision is made in the lower part of the uterus though there may be cases when a vertical incision may be required. The baby is then delivered out of your uterus and the cord is cut. The uterine incision is closed with sutures (stitches) of resorbable material. The skin sutures will have to be removed after three to seven days. Antibiotics may be administered during the procedure through an IV line. Read more about Caesarean section delivery do you really need it?

Image source: AFP

With inputs from AFP

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