Cesarean delivery “en caul” in Japan: Results of a national survey of maternal and perinatal centers in Japan

Abstract

Aim: ``En caul{''} cesarean section can prevent mechanical damage to preterm babies upon cesarean delivery, by intentionally not rupturing the fetal membranes. This survey investigates its prevalence, indications, and advantages and disadvantages in Japan. Methods: Questionnaires were posted to all registered Level 2 and Level 3 maternal and perinatal centers (where most premature babies are delivered) in Japan (n = 327). Percentages of centers are presented as survey results. Results: Response rate was 53.2\%. En caul cesarean section was employed in 43.2\% and 81.6\% of Level 2 and 3 centers, respectively. Gestational age considered for en caul cesarean section was less than 31 weeks in 75.9\% of centers. Low transverse and vertical uterine incisions were made at 64\% and 29\% of centers, respectively. En caul cesarean section was considered useful by 87\% of centers. However, nearly one-third of the respondents noted that this procedure presents some technical difficulties if membranes happen to rupture accidentally before the delivery of the fetus is complete. Conclusions: En caul cesarean section is a routine cesarean delivery technique used for preterm babies born at Level 3 maternal and perinatal centers in Japan. However, certain technical and educational aspects should be considered to achieve better outcomes.