The New Indian Journal of OBGYN. 11(1):34-40
A survey and evidence based analysis of caesarean section techniques amongst obstetricians in North India
Priya Sharma, Vartika Tripathi, Aditya Vikram, Swati Dubey, Uma Gupta
ABSTRACT
Objectives: To assess the surgical techniques used for caesarean section by obstetricians in North India and review them with respect to the current evidence. To improve the outcomes of caesarean sections through rectification of the surgical techniques, it is imperative to assess the current practices amongst the obstetricians and analyze the rationale behind their surgical preferences. Methods: This study carried out amongst practicing obstetricians in North India over a period of one month, is a descriptive, cross-sectional study which involved the use of a pre-tested questionnaire distributed online. Results: Out of total 203 respondents (50.75% response rate), the majority of respondents 140 (62.7%) were aged <40 years, were females 195 (96.06%) and112 (55.17%) had a post-PG experience of <5 years. Majority of respondents 130 (64.03%) preferred to give pre operative antibiotic one hour prior to surgery, 94(46.31%) preferred trimming while 72 (35.46%) shaving as a method of parts preparation. 197(97%) preferred transverse incision out of which 87% prefer pfannensteil. There is significant association (p value - 0.04) between the preference to use pfannensteil incision and the number of years of practice with younger obstetricians opting for pfannensteil incision. 117 (58%) practiced blunt dissection to open the abdominal layers while 86(42%) practiced sharp dissection. 92% of the obstetricians preferred to create bladder flap. Majority i.e. 117(63%) preferred blunt extension of uterine incision practice of blunt extension of the uterine incision was associated significantly (p value - 0.0004) with the years of practice of the obstetricians with senior obstetricians more in favour of blunt dissection. Majority, 65% (n=132) preferred to exteriorize the uterus while closure, 66% (n=135) preferred double layer running sutures for uterine incision closure, 76% obstetricians preferred not including decidua in uterine sutures and preferred to close visceral (60%)and parietal peritoneum (80%) and rectus muscle (65%) and subcutaneous fat (69%) as well. Conclusion: There is heterogeneity and variation in the caesarean section techniques being practiced among the obstetricians in North India, probably as the existing guidelines are not uniform regarding multiple issues. These varied practices are bound to continue until strong evidence based guidelines for the techniques of caesarean section are formulated.