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Meta-Analysis
. 2013 May 31;2013(5):CD004453.
doi: 10.1002/14651858.CD004453.pub3.

Abdominal surgical incisions for caesarean section

Matthews Mathai  1 , G Justus Hofmeyr, Namratha E Mathai
Affiliations
Meta-Analysis

Abdominal surgical incisions for caesarean section

Matthews Mathai et al. Cochrane Database Syst Rev. .

Abstract

Background: Caesarean section is the commonest major operation performed on women worldwide. Operative techniques, including abdominal incisions, vary. Some of these techniques have been evaluated through randomised trials.

Objectives: To determine the benefits and risks of alternative methods of abdominal surgical incisions for caesarean section.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013).

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

Data collection and analysis: We extracted data from the sources, checked them for accuracy and analysed the data.

Main results: Four studies (666 women) were included in this review.Two studies (411 women) compared the Joel-Cohen incision with the Pfannenstiel incision. Overall, there was a 65% reduction in reported postoperative febrile morbidity (risk ratio (RR) 0.35, 95% confidence interval (CI) 0.14 to 0.87) with the Joel-Cohen incision. One of the trials reported reduced postoperative analgesic requirements (RR 0.55, 95% CI 0.40 to 0.76); operating time (mean difference (MD) -11.40, 95% CI -16.55 to -6.25 minutes); delivery time (MD -1.90, 95% CI -2.53 to -1.27 minutes); total dose of analgesia in the first 24 hours (MD -0.89, 95% CI -1.19 to -0.59); estimated blood loss (MD -58.00, 95% CI -108.51 to -7.49 mL); postoperative hospital stay for the mother (MD -1.50, 95% CI -2.16 to -0.84 days); and increased time to the first dose of analgesia (MD 0.80, 95% CI 0.12 to 1.48 hours) compared with the Pfannenstiel group. No other significant differences were found in either trial.Two studies compared muscle cutting incisions with Pfannenstiel incision. One study (68 women) comparing Mouchel incision with Pfannenstiel incision did not contribute data to this review. The other study (97 women) comparing the Maylard muscle-cutting incision with the Pfannenstiel incision, reported no difference in febrile morbidity (RR 1.26, 95% CI 0.08 to 19.50); need for blood transfusion (RR 0.42, 95% CI 0.02 to 9.98); wound infection (RR 1.26, 95% CI 0.27 to 5.91); physical tests on muscle strength at three months postoperative and postoperative hospital stay (MD 0.40 days, 95% CI -0.34 to 1.14).

Authors' conclusions: The Joel-Cohen incision has advantages compared with the Pfannenstiel incision. These are: less fever, pain and analgesic requirements; less blood loss; shorter duration of surgery and hospital stay. These advantages for the mother could be extrapolated to savings for the health system. However, these trials do not provide information on severe or long-term morbidity and mortality.

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Conflict of interest statement

Matthews Mathai is the author of one of the included trials.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 1 Postoperative febrile morbidity.
1.2
1.2. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 2 Postoperative analgesia on demand.
1.3
1.3. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 3 Time between surgery and first dose of analgesic (hours).
1.4
1.4. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 4 Total dose of analgesics in 24 hours.
1.8
1.8. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 8 Estimated blood loss (mL).
1.10
1.10. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 10 Blood transfusion.
1.11
1.11. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 11 Wound infection as defined by trial authors.
1.16
1.16. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 16 Time (hours) from surgery to start of breastfeeding.
1.17
1.17. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 17 Total operative time (minutes).
1.18
1.18. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 18 Need for re‐laparotomy.
1.21
1.21. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 21 Delivery time (minutes).
1.23
1.23. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 23 Admissions to special care baby unit ‐ all types.
1.24
1.24. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 24 Admission to special care baby unit ‐ emergency caesarean section.
1.25
1.25. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 25 Postoperative hospital stay for mother (days).
1.26
1.26. Analysis
Comparison 1 Joel‐Cohen versus Pfannenstiel incision, Outcome 26 Stay in special care nursery (days).
2.1
2.1. Analysis
Comparison 2 Muscle‐cutting/Maylard versus Pfannenstiel incision, Outcome 1 Postoperative febrile morbidity.
2.2
2.2. Analysis
Comparison 2 Muscle‐cutting/Maylard versus Pfannenstiel incision, Outcome 2 Blood transfusion.
2.3
2.3. Analysis
Comparison 2 Muscle‐cutting/Maylard versus Pfannenstiel incision, Outcome 3 Wound infection as defined by trial authors.
2.4
2.4. Analysis
Comparison 2 Muscle‐cutting/Maylard versus Pfannenstiel incision, Outcome 4 Long‐term complication ‐ physical test at 3 months (Janda's test).
2.5
2.5. Analysis
Comparison 2 Muscle‐cutting/Maylard versus Pfannenstiel incision, Outcome 5 Postoperative hospital stay for mother (days).
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Update of

References

References to studies included in this review

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