As cesarean section rates increase globally, specialists at NYU Langone Health are drawing attention to a surgical method that may reduce long-term risks for patients. The endometrium-free closure technique (EFCT), outlined in a recent article in the American Journal of Obstetrics & Gynecology, centers on improving how the uterus is closed after a C-section.
After a cesarean delivery, some individuals develop small indentations or pockets in the uterine scar. These defects can result in symptoms such as irregular bleeding, pelvic pain, and infertility. In certain cases, they may also heighten the risk of complications during future pregnancies, including placenta accreta spectrum.
Traditional closure techniques often involve stitching through the inner lining of the uterus. Research suggests this approach might hinder proper healing. With EFCT, surgeons deliberately avoid including this inner lining in their stitches by carefully identifying it during the procedure.
According to prior studies referenced by NYU Langone Health experts, excluding the inner uterine lining from sutures leads to fewer and smaller scar defects and results in healthier tissue at the repair site. The recently published paper highlights that accurate alignment and precise closure of uterine layers are critical factors.
Dr. Antoine and colleagues indicate that more randomized trials are necessary to confirm these findings—especially for complex or emergency situations where visualizing uterine layers is more challenging. They stress that training surgeons to distinguish between different uterine layers is essential for optimal outcomes.
"Further randomized trials are needed, particularly in complex or emergency cases where the uterus may be harder to visualize," Dr. Antoine said. "We emphasize the importance of training surgeons to recognize the different layers of the uterus so they can be repaired correctly."
