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Comparative Study
. 2008 Jan 23;2008(1):CD004662.
doi: 10.1002/14651858.CD004662.pub2.

Techniques for caesarean section

G J Hofmeyr  1 , M Mathai, A Shah, N Novikova
Affiliations
Comparative Study

Techniques for caesarean section

G J Hofmeyr et al. Cochrane Database Syst Rev. .

Abstract

Background: Rates of caesarean section (CS) have been rising globally. It is important to use the most effective and safe technique.

Objectives: To compare the effects of complete methods of caesarean section; and to summarise the findings of reviews of individual aspects of caesarean section technique.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3) and reference lists of identified papers.

Selection criteria: Randomised controlled trials of intention to perform caesarean section using different techniques.

Data collection and analysis: Two review authors independently assessed studies and extracted data.

Main results: 'Joel-Cohen based' compared with Pfannenstiel CS was associated with: less blood loss, (five trials, 481 women; weighted mean difference (WMD) -64.45 ml; 95% confidence interval (CI) -91.34 to -37.56 ml); shorter operating time (five trials, 581 women; WMD -18.65; 95% CI -24.84 to -12.45 minutes); postoperatively, reduced time to oral intake (five trials, 481 women; WMD -3.92; 95% CI -7.13 to -0.71 hours); less fever (eight trials, 1412 women; relative risk (RR) 0.47; 95% CI 0.28 to 0.81); shorter duration of postoperative pain (two comparisons from one trial, 172 women; WMD -14.18 hours; 95% CI -18.31 to -10.04 hours); fewer analgesic injections (two trials, 151 women; WMD -0.92; 95% CI -1.20 to -0.63); and shorter time from skin incision to birth of the baby (five trials, 575 women; WMD -3.84 minutes; 95% CI -5.41 to -2.27 minutes). Serious complications and blood transfusions were too few for analysis.Misgav-Ladach compared with the traditional method (lower midline abdominal incision) was associated with reduced: blood loss (339 women; WMD -93.00; 95% CI -132.72 to -53.28 ml); operating time (339 women; WMD-7.30; 95% CI -8.32 to -6.28 minutes); time to mobilisation (339 women; WMD -16.06; 95% CI -18.22 to -13.90 hours); and length of postoperative stay for the mother (339 women; WMD -0.82; 95% CI -1.08 to -0.56 days). Misgav-Ladach compared with modified Misgav-Ladach methods was associated with a longer time from skin incision to birth of the baby (116 women; WMD 2.10; 95% CI 1.10 to 3.10 minutes).

Authors' conclusions: 'Joel-Cohen based' methods have advantages compared to Pfannenstiel and to traditional (lower midline) CS techniques, which could translate to savings for the health system. However, these trials do not provide information on mortality and serious or long-term morbidity such as morbidly adherent placenta and scar rupture.

PubMed Disclaimer

Conflict of interest statement

Matthews Mathai is author of a randomised trial of abdominal incisions for caesarean section.

The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or the stated policy of the World Health Organization.

Figures

1.1
1.1. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 1 Serious complications.
1.2
1.2. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 2 Blood loss.
1.3
1.3. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 3 Blood transfusion.
1.4
1.4. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 4 Operating time (minutes).
1.7
1.7. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 7 Postoperative haematocrit level.
1.8
1.8. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 8 Haemoglobin fall > 4 g%.
1.9
1.9. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 9 Wound infection.
1.10
1.10. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 10 Wound haematoma.
1.11
1.11. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 11 Wound breakdown.
1.12
1.12. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 12 Endometritis.
1.13
1.13. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 13 Time to mobilisation (hours).
1.14
1.14. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 14 Time to oral intake (hours).
1.15
1.15. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 15 Time to return of bowel function (hours).
1.16
1.16. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 16 Time to breastfeeding initiation (hours).
1.17
1.17. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 17 Fever treated with antibiotics or as defined by trial authors.
1.18
1.18. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 18 Repeat operative procedures on the wound.
1.19
1.19. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 19 Postoperative pain as measured by trial authors.
1.20
1.20. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 20 Number of analgesic injections.
1.24
1.24. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 24 Time from skin incision to delivery (minutes).
1.28
1.28. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 28 Apgar score < 7 at 5 minutes.
1.29
1.29. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 29 Neonatal intensive care admission.
1.37
1.37. Analysis
Comparison 1 Joel‐Cohen based versus Pfannenstiel (all trials), Outcome 37 Length of postoperative stay for mother (days).
4.2
4.2. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 2 Blood loss.
4.4
4.4. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 4 Operating time.
4.8
4.8. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 8 Postoperative anaemia.
4.9
4.9. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 9 Wound infection.
4.11
4.11. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 11 Wound breakdown.
4.12
4.12. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 12 Endometritis.
4.13
4.13. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 13 Time to mobilistion.
4.17
4.17. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 17 Fever treated with antibiotics or as defined by trialists.
4.37
4.37. Analysis
Comparison 4 Joel‐Cohen based versus traditional (lower midline incision) (all trials), Outcome 37 Length of postoperative hospital stay for mother.
7.2
7.2. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 2 Blood loss.
7.4
7.4. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 4 Operating time.
7.14
7.14. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 14 Time to oral intake.
7.15
7.15. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 15 Time to return of bowel function.
7.19
7.19. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 19 Postoperative pain as measured by trial authors.
7.24
7.24. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 24 Time from skin incision to delivery.
7.37
7.37. Analysis
Comparison 7 Misgav‐Ladach versus modified Misgav‐Ladach (all trials), Outcome 37 Length of postoperative hospital stay for mother.
10.1
10.1. Analysis
Comparison 10 Extraperitoneal versus intraperitoneal caesarean section, Outcome 1 Serious complications.
10.5
10.5. Analysis
Comparison 10 Extraperitoneal versus intraperitoneal caesarean section, Outcome 5 Maternal mortality.
10.17
10.17. Analysis
Comparison 10 Extraperitoneal versus intraperitoneal caesarean section, Outcome 17 Fever treated with antibiotics or as defined by trialists.
10.18
10.18. Analysis
Comparison 10 Extraperitoneal versus intraperitoneal caesarean section, Outcome 18 Repeat operative procedures on the wound.
See this image and copyright information in PMC

Update of

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