Slow caesarean section as an alternative to the traditional
AbstractThe aim of the study was to assess the characteristics of delivery in women with a history of cesarean section (CS) by slow caesarean section (CS).
Materials and methods. A prospective cohort study was performed. Main clinical bases: maternity hospitals No. 68 and No. 29 in Moscow. Study period: 2013 (January) – 2019 (July). The study included 88 pregnant women with a history of 1CS. 30 women preferred slow CS, 58 – traditional. CS was performed according to clinical protocols.
Results. More than a third (34.09%) of women with a history of CS have the opportunity to bring the experience of repeated delivery as close as possible to the natural way of slow CS. The main maternal and fetal characteristics of traditional and slow CS are practically the same: age (p=0.14), pregestational BMI (p=0.13), time interval between previous CS and current pregnancy (p=0.13), gestational age at delivery (p=0.32), amniotic fluid index (p=0.44), minimum and maximum scar thickness (p=0.09 and p=0.08), cervix maturity according to Bishop (p=0.54) were found to be comparable. The inefficiency of “expulsive efforts” imitation in slow CS was 16.67%, which does not exclude the comparability of intraoperative indicators of traditional and slow CS: time from the onset of labor to CS (p=0.05), from skin incision to fetal extraction (p=0.09); skin-toskin contact (p=0.85); from fetal retrieval to placental removal (p=0.13). Slow CS shows a trend for a longer time from skin incision to delivery of the fetus with a median and the lower quartile equal to 5 minutes. In the traditional CS, the lower quartile limit is many times lower and is 2 minutes. The advantages of slow CS in comparison with the traditional one were established: a significantly smaller width of the uterus (130.67±7.74 mm and 135.61±8.14 mm, p=0.02) and its anterior-posterior size (101.67±35.04 mm and 115.55±9.24 mm) (p=0.04). Slow CS was associated with the functional state of the fetus on the eve of delivery and assessment of the newborn on the Apgar scale, comparable to traditional CS.
Conclusion. Slow CS differs from traditional CS in minor nuances of the surgical technique, but not in maternal and fetal outcomes, and is a safe alternative. It has been confirmed that the basis of the natural CS is the reintegration of surgical manipulations into maternal efforts, which makes it possible to embody the awareness of motherhood to the maximum, to realize the connection between mother and child through physical intimacy. The existing experience of natural CS in the world indicates its demand, the possibility of providing maximum comfort to a married couple during delivery. The possibility of early familiarization with the procedure of the upcoming CS, adaptation of many parameters to preferences of mother and father, promise to prevent the traumatic experience of delivery.
Keywords:slow caesarean section; natural caesarean section; conventional caesarean section; skin-to-skin maternal-fetal contact
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Vuchenovich Yu.D., Novikova V.A., Radzinsky V.E. Slow caesarean section as an alternative to the traditional. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11. Supplement: 42–8. DOI: https://doi.org/10.33029/2303-9698-2023-11-suppl -42-48 (in Russian)
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