Experts at NYU Langone Health have highlighted a surgical technique, known as the endometrium-free closure technique (EFCT), which may help reduce the risk of long-term complications associated with cesarean delivery (C-section). This technique is detailed in a new article published online in the American Journal of Obstetrics & Gynecology.
Following a C-section, some patients may develop scar defects, or small pockets, in the uterine incision site. These defects are linked to symptoms such as irregular bleeding, pelvic pain, and infertility. In some instances, they can also elevate the risk of complications in subsequent pregnancies, including placenta accreta spectrum.
The EFCT focuses on the method used to close the uterus after a C-section to support improved healing. In many standard closure methods, the inner lining of the uterus (endometrium) is included in the stitches. Research suggests this may interfere with the healing process. With EFCT, surgeons aim to identify and avoid stitching through this inner lining.
Previous studies have indicated that excluding the endometrium from the closure is associated with fewer and smaller scar defects, as well as 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.
Clarel Antoine, MD, 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 can be reduced, potentially lowering the risk of problems in future pregnancies. Dana R. Gossett, MD, Chair of Obstetrics and Gynecology, noted the potential of this approach to enhance long-term reproductive outcomes and suggested the need for further studies to assess its full impact.
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 underscore the importance of training surgeons to accurately recognize and repair the different layers of the uterus.