A review of Caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital

Although Caesarean sections (CSs) are among the most commonly undertaken procedures in the world, there are wide variations in the surgical techniques used. This study aimed to: (a) review the surgical techniques used for CS by obstetricians working in a tertiary hospital in Singapore; (b) compare t...

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Bibliographic Details
Published in:Singapore medical journal 2017-06, Vol.58 (6), p.327-331
Main Authors: Lau, Chang Qi Hester, Wong, Tuck Chin Tiffany, Tan, Eng Loy, Kanagalingam, Devendra
Format: Article
Language:English
Subjects:
Adult
Cesarean Section - adverse effects
Cesarean Section - methods
Female
Humans
Original
Postoperative Hemorrhage - prevention & control
Pregnancy
Retrospective Studies
Singapore
Suture Techniques
Tertiary Care Centers
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Summary:Although Caesarean sections (CSs) are among the most commonly undertaken procedures in the world, there are wide variations in the surgical techniques used. This study aimed to: (a) review the surgical techniques used for CS by obstetricians working in a tertiary hospital in Singapore; (b) compare the techniques with those recommended in evidence-based guidelines; and (c) examine the relationship between the technique used and the level of seniority of the surgeons. Data on 490 CSs performed in Singapore General Hospital (SGH) between 1 August 2013 and 30 June 2014 was collected from the Delivery Suite database and reviewed. The surgical techniques studied were closure of the pelvic and parietal peritoneum, closure of the uterine layer, use of surgical drains and use of postoperative thromboprophylaxis. A total of 486 CSs were analysed after four cases were excluded due to missing data. Most fetal head deliveries were manual. The majority of surgeons did not close the peritoneum; most of those who did were senior surgeons. Double-layer uterine closures were done for all cases and drain usage was rare. 2.0% of the patients received grossly inadequate thromboprophylaxis. The surgical techniques currently practised in SGH are closely aligned with those of the evidence-based guidelines. Peritoneal closure appears to be associated with the surgeon's early training, with a greater number of senior surgeons being less willing to abandon this step. Greater vigilance in implementing appropriate thromboprophylaxis is recommended.
ISSN:0037-5675
DOI:10.11622/smedj.2016066