Maternal and fetal effect of misgav ladach cesarean section in Nigerian Women: A randomized control study

Abstract

Background:The poor utilisation of the Misgav-Ladach (ML) caesarean section method in our environment despite its proven advantage has been attributed to several factors including its non-evaluation. A well designed and conducted trial is needed to provide evidence to convince clinician of its advantage over Pfannenstiel based methods.Aim:To evaluate the outcome of ML based caesarean section among Nigerian women.Subjects and Methods:Randomised controlled open label study of 323 women undergoing primary caesarean section in Lagos Nigeria. The women were randomised to either ML method or Pfannenstiel based (PB) caesarean section technique using computer generated random numbers.Results:The mean duration of surgery (P < 0.001), time to first bowel motion (P = 0.01) and ambulation (P < 0.001) were significantly shorter in the ML group compared to PB group. Postoperative anaemia (P < 0.01), analgesic needs (P = 0.02), extra suture use, estimated blood loss (P < 0.01) and post-operative complications (P = 0.001) were significantly lower in the ML group compared to PB group. Though the mean hospital stay was shorter (5.8 days) in the ML group as against 6.0 days, the difference was not significant statistically (P = 0.17). Of the fetal outcome measures compared, it was only in the fetal extraction time that there was significant difference between the two groups (P = 0.001). The mean fetal extraction time was 162 sec in ML group compared to 273 sec in the PB group.Conclusions:This study confirmed the already established benefit of ML techniques in Nigerian women, as it relates to the postoperative outcomes, duration of surgery, and fetal extraction time. The technique is recommended to clinicians as its superior maternal and fetal outcome and cost saving advantage makes it appropriate for use in poor resource setting.

Misgav‐Ladach or modified Misgav‐Ladach versus Pfannenstiel‐Kerr methods for cesarean deliveries: A systematic review and meta‐analysis

“…Eight studies reported on analgesia use 21–23,26,31,33,41,44 . No difference was seen between MMLM and PKM (MD: −0.99 doses, 95% CI: −2.53, 0.54, Tau 2 = 2.44, I 2 = 100%) (Figure 2G1).…”

“…The total number of patients that underwent CS were 15 251. Of these, 5809 (38.1%) underwent PKM, 10,19–44 3790 (24.9%) MLM, 21,23,25,27,30–32,34–36,38–41,43 and 5597 (36.7%) MMLM 10,19,20,22,24,26,28,29,33,36,42,44 . The range of means for ages of the entire maternal cohort was 23.16–32.33 years and the gestational cohort was 36.50–39.24 weeks.…”

“…Operative time was reported in 23 studies 10,19–21,23–33,35–37,39,40,42–44 . MMLM (mean difference [MD]: −11.38 min, 95% confidence interval [CI]: −14.72, −8.04, Tau 2 = 30.56, I 2 = 100%) (Figure 1A1) and MLM (MD: −12.09 min, 95% CI: −14.40, −9.77, Tau 2 = 16.79, I 2 = 97%) had a shorter operative time compared to PKM (Figure 1A2).…”

“…Fourteen studies reported on length of hospital stay 10,21,23–26,28,30,33,36,39–41,44 . MMLM (MD: −0.58 d, 95% CI: −1.00, −0.17, Tau 2 = 0.29, I 2 = 100%) (Figure 2E1) and MLM (MD: −0.77 d, 95% CI: −1.35, −0.19, Tau 2 = 0.60, I 2 = 98%) had a shorter duration than PKM (Figure 2E2).…”

The maternal and fetal outcome of repeat previous one caesarean section

“…Our study is similar to the study of Lyell et al Lyell and other studies in which the rate of adhesion was more in the previous caesarian section. 15,[24][25][26] In the study of Bhowmk et al difficulty in opening the abdomen was countered in 74 patients (41.11%) because of adhesive between the uterus and undersurface of the rectus sheath. 27 Difficulty in the separation of the bladder was seen in 24% (13.33%) patients.…”