Experts from NYU Langone Health have highlighted a surgical technique, known as the endometrium-free closure technique (EFCT), that aims to reduce the risk of long-term complications associated with cesarean deliveries. The technique, detailed in an article published in the American Journal of Obstetrics & Gynecology, focuses on avoiding the inner lining of the uterus during closure to promote improved healing and potentially reduce the formation of scar defects.
Context and the Emerging Technique
As the global rate of cesarean deliveries (C-sections) continues to increase, a surgical technique known as the endometrium-free closure technique (EFCT) is being examined for its potential to reduce long-term complications. Experts at NYU Langone Health have detailed this technique in a new article published in the American Journal of Obstetrics & Gynecology.
Understanding Post-Cesarean Scar Defects
Following a C-section, some patients may develop scar defects, described as small pockets, in the uterine incision site. These defects are linked to symptoms such as irregular bleeding, pelvic pain, and infertility. Additionally, they can increase the risk of complications in subsequent pregnancies, including conditions within the placenta accreta spectrum.
The Endometrium-Free Closure Technique (EFCT)
The EFCT focuses on the method used to close the uterus after a C-section to support improved healing. Many standard uterine closure methods involve stitching through the inner lining of the uterus, known as the endometrium. Research suggests this may interfere with the healing process. With EFCT, surgeons aim to identify and avoid stitching through this inner lining.
Research Findings and Clinical Implications
Previous studies have indicated that excluding the endometrium from the closure is associated with fewer and smaller scar defects. These studies also reported the formation of thicker, healthier tissue at the uterine repair site. The recent publication emphasizes that precise identification and correct alignment of the uterine layers are critical for optimal outcomes.
Expert Commentary
Dr. Clarel Antoine, a clinical professor at NYU Grossman School of Medicine, stated that by not including the inner lining of the uterus during repair, scar defect formation may be reduced, potentially lowering the risk of problems in future pregnancies. Dr. Dana R. Gossett, Chair of Obstetrics and Gynecology at NYU Langone Health, noted the potential of this approach to enhance long-term reproductive outcomes and suggested the need for further studies to assess its full impact. Dr. Gossett also remarked that evidence-based refinements in surgical techniques are important given the rising global C-section rates.
Recommendations for Future Research and Training
The authors recommend that additional randomized trials be conducted, particularly in complex or emergency C-section scenarios where visualizing the uterus may be more challenging. They also underscore the importance of training surgeons to accurately recognize and repair the different layers of the uterus.