Cesarean section deliveries have increased by 50% since 1996, and as of 2007, over 32% of all deliveries in the US were C-sections.135 Currently, 1.3 million are performed each year in the US. Bacterial infections, injury to surrounding organs and post-surgical adhesions associated with C-sections can lead to serious complications impacting the short and long term recovery of the patient.Protection starts with an absorbable adhesion barrier
Multiple studies have shown that a majority of post-cesarean adhesions form between the anterior uterine wall and the abdominal wall (see chart below).
|Author||Anterior Uterine/ Abdominal wall (fascia)||Bladder flap/ Anterior Uterine|
|Morales, et al140||77%||N/A|
|Tulandi, et al149||48-53%||26-35%|
|Lyell, et al134||27%*||12%*|
Ethicon offers GYNECARE INTERCEED® Absorbable Adhesion Barrier for use in open gynecologic pelvic surgery, including C-sections. An adhesion barrier is used to reduce the incidence of postoperative pelvic adhesions after meticulous hemostasis is achieved. Based on the locations where adhesions are most likely to occur, the suggested application of GYNECARE INTERCEED Adhesion Barrier is an inverted T placement. Cut into two pieces, one layer is placed over the uterine incision and the other is placed perpendicular to the uterine incision, over the anterior uterine serosa.
Additionally, Ethicon supplies a wide range of products suitable for C-section closure including high-performing needles and absorbable and non-absorbable sutures available in a variety of materials, as well as Plus Antibacterial Sutures and DERMABOND ADVANCED® Topical Skin Adhesive for surgical incisions.
DERMABOND ADVANCED Adhesive – a unique formulation that provides patients with a triad of benefits when used in addition to sutures†,‡,1,117
- Adds strength
- Inhibits bacteria
- Provides a flexible microbial barrier
Plus Antibacterial Sutures – the only commercially available sutures with antibacterial protection.1,137,138,146,155
- Provides strength through critical healing period
- Protection against bacterial colonization of the suture by organisms commonly associated with surgical site infection
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- INDICATIONS: GYNECARE INTERCEED Absorbable Adhesion Barrier is indicated as an adjuvant in open (laparotomy) gynecologic pelvic surgery for reducing the incidence of postoperative pelvic adhesions after meticulous hemostasis is achieved consistent with microsurgical principles.
- CONTRAINDICATIONS: The use of GYNECARE INTERCEED Absorbable Adhesion Barrier is contraindicated in the presence of frank infection. GYNECARE INTERCEED is not indicated as a hemostatic agent. Appropriate means of achieving hemostasis must be employed.
- WARNINGS: The safety and effectiveness of GYNECARE INTERCEED in laparoscopic surgery or any procedures other than open (laparotomy) gynecologic microsurgical procedures have not been established.
- Postoperative adhesions may be induced by GYNECARE INTERCEED application if adjacent tissues (eg, ovary and tube) and structures are coapted or conjoined by the device, or if GYNECARE INTERCEED is folded, wadded or layered. Postoperative adhesions may occur in the presence of GYNECARE INTERCEED if meticulous hemostasis is not achieved prior to application. As with all foreign substances, GYNECARE INTERCEED should not be placed in a contaminated surgical site.
- PRECAUTIONS: Use only a single layer of GYNECARE INTERCEED, since multiple layers of packing or folding will not enhance the adhesion barrier characteristics and may interfere with the absorption rate of GYNECARE INTERCEED. Care should be exercised in applying GYNECARE INTERCEED to a pelvic organ not to constrict or restrict it. If the product comes in contact with blood prior to completing the procedure, it should be discarded, as fibrin deposition cannot be removed by irrigation and may promote adhesions formation. Ectopic pregnancies have been associated with fertility surgery of the female reproductive tract. No data exist to establish the effect, if any, of GYNECARE INTERCEED on the occurrence of ectopic pregnancies. No adequate studies have been conducted in women who have become pregnant within the first month after exposure to GYNECARE INTERCEED. No teratogenic studies have been performed. Therefore, avoidance of conception should be considered during the first complete menstrual cycle after use of GYNECARE INTERCEED. The safety and effectiveness of using GYNECARE INTERCEED in combination with other adhesion prevention treatments have not been clinically established. GYNECARE INTERCEED is supplied sterile. As the material is not compatible with autoclaving or ethylene oxide sterilization, GYNECARE INTERCEED must not be resterilized. Foreign body reactions may occur in some patients. Interactions may occur between GYNECARE INTERCEED and some drugs used at the surgical site. Pathologists examining sites of GYNECARE INTERCEED placement should be made aware of its usage and of the normal cellular response to GYNECARE INTERCEED ‘to facilitate proper evaluation of specimens'.
- ADVERSE REACTIONS: The type and frequency of adverse events reported are consistent with events typically seen following surgery. Postsurgical adhesions may occur in the presence of GYNECARE INTERCEED.
- For more information, please consult your doctor or call 1-888-GYNECARE to speak with a nurse.
- * Non peritoneal closure group
- † Clinical significance is unknown
- ‡ Effective against S. epidermidis, S. aureus, E. coli, Enterococcus faecium, Pseudomonas aeruginosa