Endometrial-free closure technique for caesarean section may help reduce risk of long-term complications

As cesarean (C-section) birth rates continue to rise worldwide, experts at NYU Langone Health are highlighting a surgical technique that may help reduce the risk of long-term complications. The endometrial-free closure technique (EFCT), described in a new article published online at American Journal of Obstetrics & Gynecologyfocuses on how the uterus closes after a C-section to support better healing.

After a C-section, some patients develop small pockets or indentations in the scar where the uterus was opened. These scar defects can cause symptoms such as irregular bleeding, pelvic pain or infertility. In some cases, they can also increase the risk of complications in future pregnancies, including the spectrum of placenta accreta.

Even small improvements in surgical technique can have significant effects on reproductive health. By avoiding the inner lining of the uterus during repair, we can reduce the formation of scar defects and reduce the risk of problems in future pregnancies.”

Clarel Antoine, MD, Clinical Professor, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine

In many common closure approaches, the lining of the uterus is included in the sutures used to close the incision, which research suggests can hinder healing. With EFCT, surgeons carefully locate this lining and avoid suturing through it.

Previous studies have shown fewer and smaller scar defects when this lining is not included in the closure, as well as thicker, healthier tissue where the uterus has been repaired. Although previous research has compared different styles of closure, this paper points out that accuracy and proper alignment of matrix layers appear to be of greater importance.

As caesarean section rates continue to rise worldwide, evidence-based improvements in technique are critical. This approach has the potential to improve long-term reproductive outcomes and future studies should be conducted to assess its impact.”

Dana R. Gossett, MD, the Stanley H. Kaplan Professor and Chair of Obstetrics and Gynecology

Dr. Antoine and study co-authors note that further randomized trials are needed, particularly in complicated or urgent cases where the uterus may be more difficult to visualize. They emphasize the importance of training surgeons to recognize the different layers of the uterus so they can be properly repaired.