AJOG AT A GLANCE
- AWhy was this study conducted?
- •The French AmbUlatory Cesarean Section (FAUCS) is a cesarean section (CS) technique which includes vertical fascial incision to the left of linea alba and extraperitoneal approach to the uterus. The presumed benefits of this technique are decreased postoperative pain and accelerated recovery. However, evidence supporting these impressions is scarce.
- •
- BWhat are the key findings?
- •Modified French Ambulatory Cesarean Section did not improve postoperative maternal recovery, and was associated with higher rates of intraoperative complications and lower neonatal pH.
- •
- CWhat does this study add to what is already known?
- •Our publication describes the results of first double-blinded randomized controlled trial examining the effects of modified French Ambulatory Cesarean Section on maternal and neonatal outcomes.
- •This is the first study showing adverse effect of this technique on neonatal outcomes and intraoperative complications.
- •
Abstract
BACKGROUND
The French AmbUlatory Cesarean Section (FAUCS) is a cesarean section (CS) technique
which includes vertical fascial incision to the left of linea alba and extraperitoneal
approach to the uterus. The presumed benefits of this technique are decreased postoperative
pain and accelerated recovery. However, evidence supporting these impressions is scarce.
OBJECTIVE
To compare maternal recovery following FAUCS vs. standard CS technique.
STUDY DESIGN
In this double-blind randomized controlled trial, women undergoing elective CS at
term were allocated into FAUCS vs. standard CS technique. A modified FAUCS operation
was utilized (mFAUCS), adhering to all FAUCS operative steps except for the extraperitoneal
approach. In both groups, intravenous hydration, intrathecal morphine and bladder
catheter were avoided, and all women were encouraged to stand and walk 3-4 hours after
the operation. The primary adverse composite outcome included either of the following:
VAS score >6 at 3-4 hours, inability to stand up and walk to the restroom 3-4 hours,
and Quality of Recovery (QoR) score-15 of <90 at 24 hours. The women were followed
for 6 weeks.
RESULTS
Overall, 116 women were included in the trial (58 in each group). The adverse composite
outcome did not differ between the two groups – 38.9% for mFAUCS group vs. 53.8% for
regular CS cohort (p=0.172). In both groups, over 90% of the women were able to get
up and walk 3-4 hours after the operation. In the mFAUCS group, longer duration of
the operation was noted (54.4±11.3 vs. 43.7±11.2 minutes, p<0.001), as well as higher
rate of intraoperative complications (13.8% vs. 0.0%, p=0.006), and higher rate of
umbilical cord pH < 7.2 (17.2% vs. 3.4%, p=0.029). Phone-call evaluation one week
following the operation showed better QoR scores in the mFAUCS group (24.6±8.0 vs.
27.1±8.4, p=0.043). Other secondary outcomes did not differ between the two groups.
CONCLUSIONS
Since excellent maternal recovery was noted in both groups, we believe that the main
factor affecting this recovery is the perioperative management (including avoidance
of intraoperative intravenous hydration, intrathecal morphine and bladder catheter,
with early postoperative mobilization). The maternal and neonatal safety of the FAUCS
operation remain to be proven by larger-scale high-quality randomized controlled trials.
KEY WORDS
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Article info
Publication history
Accepted:
February 15,
2023
Received in revised form:
February 8,
2023
Received:
January 8,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
