Modification of cesarean section operative technique by Vejnovie

Vejnovie modification of cesarean section represents an improvement of previous operative

techniques. Vejnovie introduced a new perspective on cesarean section as an imitation of vaginal
delivery. This point of view induced changes in each step of the operation (opening of the anterior
abdominal wall, opening of the uterus, delivering the baby and placenta, revision of the uterine
cavity and dilation of the cervix, uterus suturing, closing of the anterior abdominal wall), which
reduced the traumatization of the tissue, and supported healing and physiological postpartum
processes.
According to that, three basic principles of Vejnovie modification were defined:
1. Minimal tissue trauma 2. Minimal operation time 3. Imitation of vaginal delivery.
The principle of imitation of vaginal delivery involves the creation of a new birth canal,
which is tailored for an individual fetus. It means that the opening of the abdominal wall and the
uterus should be the smallest possible for the baby to pass through, using the same mechanism as in
vaginal delivery. In this way, pressure is achieved on the head and chest of a newborn, which helps
to squeeze out fetal lung fluid, thus providing better transition to air breathing.
The most significant contribution of the modified technique is a new way of uterus suturing.
It is also based on the principle of imitation of natural processes, especially of the uterus involution
after delivery. According to Vejnovie modification, uterus suturing is performed in four steps. By a
particular order of placing the stitches and tightening the knots, the length of the uterus incision
already intraoperatively gets twice shorter. Centripetally directed vectors of the force within the
scar, contribute to its further reduction in the postoperative period and preserving the thickness of
the uterine wall. Everything above-mentioned provides faster and better healing of the uterus and
reduces the risk of acute complications (bleeding and infection), as well as chronic complications of
caesarean section in future pregnancies (rupture of the uterus and placenta accreta) which may
cause much greater morbidity and potentially fatal consequences.
It has been scientifically confirmed that this modified technique leads to a significant
reduction in blood loss, the length of the operation and stay in hospital, as well to the reduction in
suture material consumption and use of instruments. Likewise, patients operated with Vejnovie
modification experienced less postoperative pain, used fewer painkillers, and had less surgical
wounds complications.
A retrospective study showed that among the 15.000 patients operated only by using
Vejnovie modification, there was no case of placenta accreta, which is considered to be the most
serious complication of cesarean section.
This operative technique was presented in over fifteen health centers in the world. In several
clinics in Europe (Serbia, Germany, Austria, Hungary, Romania), Vejnovie modification is adopted
and applied regularly.
In 2017, the Ministry of Health of the Republic of Serbia approved the implementation of
the Modification of cesarean section operative technique by Vejnovie as scientifically proven
and tested new health technology.
In order to provide a precise explanation of the modified technique and a better quality of
education for surgeons, 3D animation of modified uterus suturing by Vejnovie was made and this
educational course was organized.