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• W2008045112 abstract "Hofmeyr et al1Hofmeyr J. Novikova N. Mathai M. Shah A. Techniques for cesarean section.Am J Obstet Gynecol. 2009; 201: 431-444Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar wrote a very interesting comparison of the various techniques for performing a cesarean delivery. However, I was struck by the operating times, which, with 1 exception,2Darj E. Nordstrom M. The Misgav Ladach method for cesarean section compared to the Pfannenstiel method.Acta Obstet Gynecol Scand. 1999; 78: 37-41Crossref PubMed Scopus (70) Google Scholar range from 27.5 to 56.5 minutes. The one exception (the Misgav Ladach technique) involves a good deal of finger dissection, which I find awkward, and only a single-layer uterine closure. It is possible to do a cesarean delivery in 15 minutes without rushing and to include a double-layer uterine closure and a subcuticular skin closure.The biggest time saver is a 2-layer, 1-suture, 1-knot uterine closure. I tag the closure stitch and then sew away from myself with a locking first layer. Without cutting or tying the suture, I then bring it back with a parallel Lambert-type imbricating stitch, tying the suture to the previously tagged end. The procedure takes 2 minutes and provides a hemostatic closure with no raw edges to invite adhesions.The second biggest time saver is to avoid electrocautery until the very last. As a cutting tool, the scalpel is a much faster and less destructive way of getting to and partially through the fascia. Typically all those bleeders encountered on entry will have stopped by closure and cautery will not be needed at all.It is also faster and gentler on epithelial surfaces to use suction or saline rinse, rather than sponges to keep the field clean. Leaving the uterus in the abdomen and making the uterine incision above the bladder, instead of reflecting it, likewise saves time and trauma.A nice side effect of the aforementioned approach is that pelvic adhesions seem to be very rare, even on higher-order repeats. I have no formal study of the subject but have personally performed more than 4000 cesarean deliveries and nearly always find a completely clean pelvis on reentry. Hofmeyr et al1Hofmeyr J. Novikova N. Mathai M. Shah A. Techniques for cesarean section.Am J Obstet Gynecol. 2009; 201: 431-444Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar wrote a very interesting comparison of the various techniques for performing a cesarean delivery. However, I was struck by the operating times, which, with 1 exception,2Darj E. Nordstrom M. The Misgav Ladach method for cesarean section compared to the Pfannenstiel method.Acta Obstet Gynecol Scand. 1999; 78: 37-41Crossref PubMed Scopus (70) Google Scholar range from 27.5 to 56.5 minutes. The one exception (the Misgav Ladach technique) involves a good deal of finger dissection, which I find awkward, and only a single-layer uterine closure. It is possible to do a cesarean delivery in 15 minutes without rushing and to include a double-layer uterine closure and a subcuticular skin closure. The biggest time saver is a 2-layer, 1-suture, 1-knot uterine closure. I tag the closure stitch and then sew away from myself with a locking first layer. Without cutting or tying the suture, I then bring it back with a parallel Lambert-type imbricating stitch, tying the suture to the previously tagged end. The procedure takes 2 minutes and provides a hemostatic closure with no raw edges to invite adhesions. The second biggest time saver is to avoid electrocautery until the very last. As a cutting tool, the scalpel is a much faster and less destructive way of getting to and partially through the fascia. Typically all those bleeders encountered on entry will have stopped by closure and cautery will not be needed at all. It is also faster and gentler on epithelial surfaces to use suction or saline rinse, rather than sponges to keep the field clean. Leaving the uterus in the abdomen and making the uterine incision above the bladder, instead of reflecting it, likewise saves time and trauma. A nice side effect of the aforementioned approach is that pelvic adhesions seem to be very rare, even on higher-order repeats. I have no formal study of the subject but have personally performed more than 4000 cesarean deliveries and nearly always find a completely clean pelvis on reentry. Techniques for cesarean sectionAmerican Journal of Obstetrics & GynecologyVol. 201Issue 5PreviewThe effects of complete methods of cesarean section (CS) were compared. Metaanalysis of randomized controlled trials of intention to perform CS using different techniques was carried out. Joel-Cohen–based CS compared with Pfannenstiel CS was associated with reduced blood loss, operating time, time to oral intake, fever, duration of postoperative pain, analgesic injections, and time from skin incision to birth of the baby. Misgav-Ladach compared with the traditional method was associated with reduced blood loss, operating time, time to mobilization, and length of postoperative stay for the mother. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 203Issue 2PreviewThank you for the comments on our systematic review of randomized trials of various methods of cesarean section.1 We agree that the operating times reported for the various methods studied in the randomized trials appear long, compared with our experience. What is of importance is the comparisons of the time taken for different methods under similar circumstances in randomized trials. The Misgav-Ladach method was significantly faster than other methods, using a single layer locking continuous suture similar to that described by the author for his first layer. Full-Text PDF" @default.
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• W2008045112 date "2010-08-01" @default.
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• W2008045112 title "The fifteen minute cesarean delivery" @default.
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