Improving Safety in Cesarean Deliveries: Key Insights from the FIGO Recommendations and Nunes et al 2023 Study

OBGYN Library Team
Aug 7
3 min read

Cesarean delivery remains one of the most common surgical procedures worldwide, yet it carries risks that can affect both mother and baby. Improving surgical techniques is essential to reduce complications and enhance patient outcomes. The International Federation of Gynecology and Obstetrics (FIGO) recently published good practice recommendations on cesarean delivery techniques, drawing on the latest evidence, including the comprehensive study by Nunes et al. (2023). This blog post explores the key findings from that study and FIGO’s guidance, offering practical tips for healthcare professionals to improve safety during cesarean sections.

Eye-level view of a surgical team performing a cesarean delivery in an operating room — Surgical team performing cesarean delivery with focus on sterile technique

Understanding the FIGO Recommendations on Cesarean Delivery

FIGO’s recommendations aim to standardize cesarean delivery techniques to minimize maternal and neonatal complications. The guidelines emphasize evidence-based practices that address common risks such as infection, hemorrhage, and injury to surrounding organs.

Key points include:

Skin incision choice: A transverse (Pfannenstiel) incision is preferred over vertical incisions for better healing and reduced pain.
Uterine incision: A low transverse uterine incision is recommended to reduce bleeding and improve healing.
Blunt versus sharp dissection: Blunt dissection of the uterine wall and fascia is advised to minimize tissue trauma.
Closure techniques: Single-layer uterine closure may be sufficient in low-risk cases, but double-layer closure is preferred in certain situations to reduce uterine rupture risk in future pregnancies.
Peritoneal closure: FIGO suggests that non-closure of the peritoneum can reduce operative time and postoperative pain without increasing complications.

These recommendations reflect a balance between surgical efficiency and patient safety.

Insights from the Nunes et al. (2023) Study

The study by Nunes and colleagues reviewed over 10,000 cesarean deliveries to evaluate the impact of different surgical techniques on maternal and neonatal outcomes. Their findings support many of FIGO’s recommendations and add valuable data on specific practices.

Key Findings

Blunt dissection reduces blood loss: The study found that blunt dissection of the uterine wall and fascia led to significantly less intraoperative bleeding compared to sharp dissection.
Single-layer uterine closure is safe in selected cases: For women without risk factors for uterine rupture, single-layer closure did not increase adverse outcomes.
Non-closure of the peritoneum shortens surgery time: Omitting peritoneal closure reduced operative time by an average of 10 minutes without increasing infection rates.
Use of prophylactic antibiotics: Administering antibiotics before skin incision lowered the risk of postoperative infections.
Skin closure with staples increased wound complications: The study showed higher rates of wound infection and dehiscence with staples compared to sutures.

These findings reinforce the importance of technique selection tailored to patient risk profiles.

Practical Tips to Improve Safety During Cesarean Sections

Healthcare professionals can apply these insights to optimize cesarean delivery outcomes. Here are practical tips based on FIGO’s recommendations and the Nunes et al. study:

Choose the appropriate skin incision: Use a Pfannenstiel incision for most cases to reduce postoperative pain and improve cosmetic results.
Use blunt dissection carefully: Employ blunt dissection for the uterine wall and fascia to minimize bleeding and tissue damage.
Select uterine closure method based on risk: Consider single-layer closure for low-risk patients but opt for double-layer closure if there is a history of uterine surgery or other risk factors.
Skip peritoneal closure when appropriate: Avoid peritoneal closure to reduce surgery time and postoperative discomfort unless specific indications exist.
Administer prophylactic antibiotics timely: Give antibiotics before the skin incision to lower infection risk.
Prefer sutures over staples for skin closure: Use absorbable sutures to reduce wound complications.
Monitor for hemorrhage and infection: Maintain vigilance during and after surgery to detect and manage bleeding or signs of infection early.
Educate surgical teams: Regular training on updated techniques and protocols ensures consistency and safety.

Implications for Patient Care

Adopting these surgical practices can lead to:

Reduced maternal morbidity: Less bleeding and fewer infections improve recovery and reduce hospital stays.
Better neonatal outcomes: Efficient surgery with minimal complications supports newborn health.
Improved patient satisfaction: Less pain, faster healing, and better cosmetic results enhance the childbirth experience.
Cost savings: Shorter operative times and fewer complications reduce healthcare costs.

Healthcare providers should integrate these recommendations into clinical protocols and tailor them to individual patient needs.

Cesarean delivery techniques continue to evolve with ongoing research. The FIGO recommendations and the study by Nunes et al. provide clear guidance to improve safety and outcomes. By applying these evidence-based practices, surgical teams can enhance care quality and support healthier mothers and babies. Staying informed and committed to best practices is essential for all professionals involved in cesarean deliveries.

REFERENCE:

Nunes I, Nicholson W, Theron G, . FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery. Int J Gynecol Obstet. 2023; 163(Suppl. 2): 21-33. doi:10.1002/ijgo.15117