October 21st, 2017

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Extraperitoneal Cesarean Delivery: A Preliminary Report
Authors:  Thomas Q. Zheng, M.D., and Dean V. Coonrod, M.D., M.P.H.
  OBJECTIVE: To summarize our experience with extraperitoneal cesarean delivery (ECD) in a residency training program. ECD has become a forgotten art in the United States.

STUDY DESIGN: Twenty patients underwent ECD through left paravesical space between February 2013 and February 2015. Indications for cesarean delivery included elective repeat cesarean, breech presentation, and failure to progress. Patients with the following conditions were excluded from ECD: need for concomitant intraabdominal procedures, emergency cesarean, placenta previa, fetal macrosomia, and <34 weeks of gestation.

RESULTS: ECDs were mostly performed by 4th and 2nd year residents with one attending obstetrician scrubbed in for the key steps. Fifteen out of 20 patients had a history of cesarean delivery. Gestational ages were from 360/7 to 420/7 weeks. Birth weights ranged from 2,470 to 4,260 g (3,360.95±462.88). Quantitative blood loss ranged from 200 to 1,050 mL (661.2±253.5). Total operative times were from 40 to 81 minutes (54.5± 12.68). Incidental peritoneal fenestrations occurred in 8 cases (40%). Vacuum extraction was used in 12 cases (60%).

CONCLUSION: In select patient populations, ECD can be performed in an educational setting without an apparent increase in surgical complications.
Keywords:  abdominal delivery, cesarean section, extraperitoneal cesarean section, graduate medical education, obstetric delivery, obstetric surgical procedure
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