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Saturday, April 12, 2014

Trailers (79): Adhesion barriers and cesarean delivery

Edwards, et al. Carboxymethylcellulose adhesion barrier placement at primary cesarean delivery and outcomes at repeat cesarean delivery

Why should you read about this topic?

When you’re using a device this expensive you should know what your patient is getting for the money.

What were the authors trying to do?

Assess the benefit of carboxymethylcellulose adhesion barrier placed at primary cesarean delivery by observing important clinical outcomes at repeat cesarean delivery

Who participated and in what setting?

Women (N=517) undergoing primary cesarean delivery (transverse skin and uterine incisions) and first repeat cesarean delivery between 2008 and 2011 at the Banner Health System in Arizona

What was the study design?

Retrospective cohort comparing women who received the adhesion barrier to women who did not

What were the main outcome measures?

Incision to delivery time at repeat cesarean

What were the results?

Times to delivery were not different between groups. Surgical complications were not different between groups but the study was not powered to adequately settle that issue.

What is the most interesting image in the paper?

Table 4

What were the study strengths and weaknesses?

Strengths: large sample size.  Weaknesses:  retrospective chart review; potential confounding by delivery hospital; not powered for surgical complications.

What does the study contribute for your practice?

So far, there is no demonstrated clinically significant benefit to using Seprafilm at cesarean delivery.