doiSerbia

Cesarean delivery - Vejnovic modification

Vejnović Tihomir R. (Clinical Centre of Vojvodina, Clinic of Gynecology and Obstetrics, Novi Sad)

INTRODUCTION. Cesarean delivery is the most common obstetric surgery today. Improvement of operative techniques, anaesthesia, care and transfusion has contributed to the safety of the procedure and expansion of indications. The operative technique usually consists of opening the abdominal wall by inferior transverse incision, isthmococervical transverse incision, and closing the uterus by continuous suture after delivering the neonate. Peritonisation is not obligatory. The last is the repair of the abdominal wall. The main characteristic of Vejnović modification is shortening uterus suture so the subsequent scar is smaller. The fascia is opened by sharp dissection, the uterus is opened with scissors at the 20-30 degrees angle, the neonate is spontaneously expulsed (not taken out), the placenta is delivered by cord traction with simultaneously massage of the fundus , peritonisation is not performed and the skin is sutured with a continuous intradermal suture. OBJECTIVE. The objective of this study is to point out the advantages of Vejnović modification vs. commonly used operative techniques. METHOD. A retrospective and prospective random study was designed, which comprised 1886 subjects delivered by C-section, a modification developed at the Clinic of Gynecology and Obstetrics, Novi Sad, from 2000-2006. A control group comprised 100 patients delivered from 1991 to 2006 by "common" operative technique (s.c. Doerfler, abdominal opening by Pfannenstielu, transversal incision o of the lower uterine segment, peritonisation using continuous sutures to repair the abdomen). We used Student’s t-test for statistical analysis. RESULTS. The modified technique showed to be twice shorter that the usually used technique, the used suture material was twice lower, hospital stay was shorter, with blood loss lower for 30.9%, and there were less complications, which was all of statistical significance (p<0.01). CONCLUSION. The modified technique proved to have both medical and economic advantages. In the future, we plan to conduct a prospective study with more subjects (both in control and experimental groups) in order to evaluate the number and size of adhesions after laparatomy by Pfannenstiel (s.c. Doerfler elaparotomies and modified repeated laparotomies.

Keywords: Cesarean delivery, modification, benefits