Techniques for caesarean section

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

“…Primary outcome data are not treated as missing if a primary outcome event is recorded on the post-partum form (ie, before the 6 weeks after delivery form). 6 This review included 11 randomised controlled trials (with a total of 1740 women) that compared diff erent approaches to abdominal entry, which are comparable to the comparison blunt versus sharp abdominal entry in the CORONIS trial (described as Joel-Cohen based versus Pfannenstiel). The fi ndings from this review suggested that the blunt approach to abdominal entry led to less blood loss, a shorter duration of surgery (including a shorter duration from skin incision to delivery of the baby), and less postoperative fever and pain.…”

“…Long-term clinical and obstetric problems include chronic pain, infertility, bowel obstruction, abnormal placen tation and its consequences, and uterine rupture. [4][5][6] Caesarean section is not done in a standardised way, and there are variations in the surgical techniques used. 7,8 Many of the surgical techniques have not been rigorously assessed in randomised controlled trials and so whether any of them are associated with better outcomes for women and babies is not known.…”

Comparison of uterine exteriorization and in situ repair during cesarean sections

“…With the recent increases in the rates of the procedure, it is important to understand and implement the optimal surgical technique. Different operational techniques have been defined to reduce the risk of peri-and postoperative morbidity [1]. Randomized, controlled studies have revealed discordant results regarding the optimal surgical technique [2][3][4][5][6].…”

New and underutilised technologies to reduce maternal mortality and morbidity: what progress have we made since Bellagio 2003?

“…A 2008 Cochrane review of techniques for caesarean section summarises the best available evidence on specific aspects of the surgery. 79 The authors conclude that simplified surgical techniques offer advantages that may be especially important in low-resource settings. The simplified Joel-Cohen-based (Joel-Cohen, Misgav-Ladach) techniques use a straight transverse abdominal incision (higher than the Pfannenstiel incision), manual separation of the abdominal wall layers to minimise sharp dissection, a transverse incision of the myometrium not larger than the amniotic sac, uterine closure in a single layer, and nonclosure of the peritoneum.…”

“…Although results of a Cochrane review of single-layer versus double-layer closure of the uterine incision suggest that single-layer closure is associated with less blood loss, postoperative pain, and shorter procedure and hospital stay, 83 other observational studies demonstrated that use of a single-layer closure led to increased uterine rupture in subsequent pregnancies. 84,85 Based on the available evidence, Hofmeyr et al 79 recommend that in low-resource settings, where caesarean sections are often performed by relatively junior staff under difficult circumstances and where women may not always be able to access caesarean surgery during subsequent pregnancies, the most cost-effective practice is to use spinal analgesia, Joel-Cohen-based abdominal incision, and double-layer closure of the uterus.…”