THE FRENCH AMBULATORY CESARIAN SECTION (FAUCS) – MATERNAL AND NEONATAL OUTCOMES: 5 YEARS CLINICAL EXPERIENCE

Abstract

Introduction. Caesarian Section is one of the most commonly performed operations worldwide. Extraperitoneal French Ambulatory Caesarian Section (FAUCS) has evolved in order to improve maternal well-being to return quickly to “normal” function. FAUCS includes a paramedian vertical opening of the aponeurosis, left (right) paravesical extraperitoneal approach of the uterus, a purse string suture of the uterine wall and glue skin closure. Modified FAUCS (mFAUCS) technique include the same approach but intraperitoneal low segment transverse uterine incision.

Materials and Methods. Since 03.2018 till 07.2023 in DDC was done 1245 FAUCS and 103 mFAUCS. The protocol for all patient’s Included decreased fluid load and avoidance of urinary catheter, spinal anesthesia with no use of morphine, active participation of the mother in “abdominal birth” by the use of a blowing mouth piece, immediate skin to skin contact and skin closure using intradermal suture and glue. Postoperative protocol included early eating and mobilization after 3–5-hour, paracetamol and/or anti-inflammatory nonsteroid agents. For comparing 250 classical c/s in low segment was analysis.

Results: From 1245 FAUCS was done the first time – 509 (40.88%), after standard C/S: second – 632 (50.76%), third - 71 (5.7%), fourth - 33 (2.65%). The repeated FAUCS was done in 29 (2.3%) cases. All mFAUCS was repeated. In 18 cases of repeated (3-th and 4 th) FAUCS temporally small incision of peritoneum for tube sterilization with subsequent closing of peritoneum was done. Age 20-52 y.o. BMI ≥30 – 39.9 kg/m ² - 42 (3.37%), BMI ≥ 40 kg/m² - 11 (0,9%) cases.

Gestation age: 36 – 41 w. Vertex presentation - 1098 (88.2%), breech – 71 (5.7%), twins - 76 (6.1%). FAUCS was feasible in all cases; surgeons achieved a completely extraperitoneal approach in (85.6%) cases. This was depending scar tissue, elasticity of tissue after previous C/S, anatomical peculiarity, surgery experience. The main difficulty experienced was fetal extraction in vertex. Newborn weight 2000 – 5000 gr. 21 (1.9%) times in vertex used forceps. All Apgar on first min ≥ 8. Average blood lost 440 ± 90 ml. Average operation time - 40.3± 11.5 min.

92% were able to get up and walk 3-5 h after the CS, 29 (2.4%) needs opiate one time, 66 (5.3%) needs no painkiller. After several hours patients were active, were able to take care of themselves and newborn, take a food, urinated. Patients were very satisfied and happy, especially that category which has previous conventional intraperitoneal C/S when comparing the postoperative period. 87% patients were ready for discharge on 2-3 days after operation. Complication – small injuring the urine bladder -2 (0.16 %), paravesical hematoma – 2 (0.16 %).

Conclusion. The FAUCS (with modification) procedure may issue in a significant diminution of morbidity, demand less painkiller drugs, more comfortable for patients, safe and improved maternal recovery. The training period with an experienced surgeon recommended to avoid complication.