Archive for May, 2010

A look at the data on hysterotomy closure – how many layers?

Given that cesarean delivery is the second most common surgery performed in this country, it is somewhat surprising that as a profession we can’t seem to settle on what the best way to do it is.  We argue about how we should open, what we should close on the way out, and how we should close these layers.  Some have even argued that we shouldn’t even enter the peritoneal cavity in doing the surgery, which leads to a radically different approach.

Of all the variations on this surgery, one element that has been up to a great deal of discussion is how many layers we should close the uterus in.   Like many things in surgical and clinical technique, the answer to this question seems to have changed over time, and has even gone back and forth.   When I was training in the late 90’s, we were closing the uterus with a single layer of chromic gut suture.  Towards the end of my training, we slid towards a double layer of gut, and now we are seeing some movement back towards a single layer, but now with polygalactin 910 (Vicryl or Polysorb.)

There have been two separate areas of concern with how many layers we should close with.  One of these concerns have been the immediate effects of how we close the uterus on patient factors such as immediate postop pain, infection rates, blood loss, and surgical time.  The second concern has been the effect of closure technique on uterine rupture rate in subsequent VBAC attempts.

Like all areas of controversy, there are surgeons that are passionate on either side.  There are also groups of non-physicians that have taken strong stands on this issue, which to surgeons can seem a little out of place given the heterogeneity of the data and the variable interpretations of that data.
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Categories: Obstetrics

Academic OB/GYN Podcast Episode 21 – ACOG 2010 Tuesday Posters

Posters from Tuesday of  2010 ACOG ACM!  Enjoy.  Thank you to Sage Healthcare for sponsoring the Academic OBGYN meetup at ACOG ACM!

Academic OB/GYN Podcast Episode 21 – ACOG 2010 Tuesday Posters

Academic OB/GYN Podcast Episode 20 – ACOG 2010 Monday Posters

In this short episode we hear from a number of researchers about their projects presented at the 2010 ACOG ACM!  Enjoy.  Thank you to Sage Healthcare for sponsoring the Academic OBGYN meetup at ACOG ACM!

Academic OB/GYN Podcast Episode 20 – ACOG 2010 Monday Posters

Academic OB/GYN at ACOG!

Well folks – I’m in San Francisco at ACOG.   In addition to the dinner monday, we will be doing a fair amount of ACOG content.   Check back for daily summaries of what’s going on at ACOG, including podcasts with interviews with poster presenters and industry folks.

If anyone wants to come to the dinner monday night, please RSVP soon!  We’ve got about 16 coming so far.  Sage Healthcare is sponsoring, so come on out and enjoy some great food and drink and meet other fans of Academic OB/GYN!

Categories: ACOG ACM, Fun Stuff, General

Academic OB/GYN Podcast Episode 19 – Fixing American Healthcare

I talk to Dr Richard Fogoros (@DrRich1), author of Fixing American Healthcare, a book presenting a theory of the fundamental error in the American healthcare system and a proposed solution.  Dr Fogoros is also the creator of The Covert Rationing Blog ( and a former academic Cardiologist.  I hope you all enjoy!

Academic OB/GYN Podcast Episode 19 – Fixing American Healthcare

Buy Fixing American Healthcare at Amazon or Barnes and Noble

Come meet with Academic OB/GYN fans at ACOG!

We will be having a get together for fans of the Academic OB/GYN podcast and blog at the ACOG ACM this year.  It will be at the XYZ Restaurant and Bar in the W Hotel on Monday 5/17/10 at 8 PM.  Reservations will be under Academic OB/GYN.

Please RSVP to if you plan on coming so I have an idea of how much table space we need.

Please come out and have some fun and good discussion.

Update – the dinner is now sponsored by Sage Software, makers of some of the top EMR software in the industry.  Thank you to Sage for sponsoring the Academic OB/GYN meetup!

Categories: ACOG ACM, Fun Stuff
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