Cesarean Surgical Technique Reduces
Long-Term Maternal Complications
Endometrium-free closure technique for hysterotomy incision at cesarean delivery
Antoine, Clarel et al.
American Journal of Obstetrics & Gynecology, Volume 233, Issue 6, Jan 2, 2026
As cesarean births continue to rise worldwide, a groundbreaking study published in the American Journal of Obstetrics and Gynecology* is changing how experts think about C-sections showing that how the uterus is closed during surgery may play a key role in preventing serious complications in future pregnancies, including Placenta Accreta Spectrum (PAS).
The research focuses on the Endometrium-Free Closure Technique (EFCT), a method of closing the uterus that restores natural tissue alignment while protecting the uterine lining. Based on decades of patient data, the study found that women whose C-sections used this technique experienced better healing, fewer scar-related problems, and much lower rates of abnormal placental attachment in pregnancies.“This changes the conversation,” said Dr. Clarel Antoine, a board-certified obstetrician and maternal-fetal medicine specialist, Founder and Chair of Rx Compassion, and a practicing Clinical Professor at NYU Langone Health, and lead author of the study. “Placenta accreta is not inevitable. Our findings show that when we respect uterine anatomy during cesarean repair, we can reduce the conditions that lead to catastrophic outcomes later on.”
Cesarean Sections Over 100 Years 1920–2020:
The Good, the Bad and the Ugly
Cesarean delivery occurs in 1 in 3 women in the US, and in up to 4 of 5 women in some regions of the world. The cesarean delivery rate increased steadily from 5% to 30–32% from 2010 - 2020, along with an increase in costs as well as short- and long-term complications. What was once used as a last resort, is now the default procedure in many cases, even though it leads to complications.
Featured in: Journal of
Perinatal Medicine
Uterine incision closure:
Is it the culprit in the cesarean scar niche and related complications?
Classic c-section closure techniques are linked to the development of scars which lead to complications during and after deliver in a woman's later pregnacies. Dr. Clarel Antoine, Rx Compassion's Founder & Board Chair, recommends more modern, alternative techniques.
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The Impact of Uterine Incision Closure Techniques on Post-cesarean Delivery Niche Formation and Size
This study of 45 women demonstrates a connection between different hysterotomy techniques and future complications. Specifically, the endometrium-free uterine closure technique is much safer.
Featured in: Journal of Ultrasound in Medicine
Origin of a Post–Cesarean Delivery Niche:
Diagnosis, Pathophysiologic Characteristics, and Video Documentation
This study demonstrates that classic c-section closure techniques do correlate with niche development along the incision site, which is a risk factor for placenta accreta and other complications. This suggests a need for new techniques, including endometrium-free uterine closure (EFCT).
Featured in: Journal of Ultrasound in Medicine:
Endometrium-free uterine closure technique and abnormal placental implantation in subsequent pregnancies
In 727 women, endometrium-free uterine closure technique led to zero (0) implantations of the placenta along the cesarean scar. Additionally, even in repeat cesarian deliveries, there was virtually no maternal hemorrhaging, postoperative complications, or neonatal complications. This makes a very strong case for adopting EFCT on a more widespread basis.
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In the News
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Researchers further confirm the benefit of the endometrium-free uterine closure technique.
