CHICAGO – The use of a sodium hyaluronate–carboxycellulose adhesion barrier during primary cesarean delivery was not associated with decreased delivery time or improved adhesion scores during a first repeat cesarean delivery in a cohort study involving 97 women.
The incision to delivery time among 71 women who did not receive sodium hyaluronate–carboxycellulose (HA-CC) barrier film during their primary cesarean delivery was 9.5 minutes, compared with 10.6 minutes in 26 women who did receive HA-CC barrier film, Dr. Maria Gaspar-Oishi of the University of Hawaii, Honolulu, reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.
Average blood loss and adhesion scores also were similar in the two groups. Blood loss was 564 mL and 563 mL, in the groups, respectively; mean fascia adhesion scores were 1.45 and 1.31; and mean intraperitoneal adhesion scores were 1.11 and 0.92, said Dr. Gaspar-Oishi, whose paper received a Donald F. Richardson Memorial Prize Paper award as one of the best papers by a junior fellow at the meeting.
Patients included in the combined prospective/retrospective cohort study were women who gave birth at a single center. Intraoperative data were collected prospectively at the time of first repeat cesarean delivery, and a retrospective chart study was performed for each subject to determine whether HA-CC barrier film was used during the primary cesarean delivery. The two study groups were similar with respect to age, body mass index, parity, and gestational age.
HA-CC barrier film is commonly used in gynecologic and other surgeries in an effort to reduce the risk of postoperative adhesions, which can result in significant morbidity – including pain, infertility, and bowel obstruction, Dr. Gaspar-Oishi said.
Data with respect to the use of HA-CC barrier film for cesarean delivery, however, are limited. In fact, this is the first prospective study to show that barrier film use does not improve delivery time or adhesion severity in subsequent cesarean deliveries, she noted.
The findings support a recent commentary in Obstetrics & Gynecology, which stated that the routine use of HA-CC barrier film is ill advised because of a lack of evidence regarding clinical benefit, she noted.
Although limited by the fact that about 80% of the women in the study were Asian American (an accurate reflection of the population served by the study hospital), the findings are nonetheless important, because an estimated 90% of all primary cesarean deliveries will result in a repeat cesarean delivery, and because HA-CC barrier film use can be costly, she said.
Additional study in a more diverse population is needed to allow for more generalized conclusions, she noted.
Dr. Gaspar-Oishi reported having no relevant financial disclosures.