A study of various cesarean section techniques at a government tertiary care centre: Misgav Ladach cesarean section versus Pfannenstiel cesarean section

Abstract

Background: It is important to examine every step in any surgery to identify and evaluate its imortance, necessity and purpose with a view to find its better alternatives if they can be found at all. The most appropriate surgical procedure is the one which takes minimum time to be complete, simplest to perform, causing least damage and least complication for the patient. Present study was undertaken to assess the benefits of the Misgav Ladach cesarean section technique in comparison to the conventional Pfannenstiel technique in the tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative pain and post-operative stay in hospital.Methods: All the women posted for emergency cesarean section in the Obstetrics OT at Sir T Hospital, Bhavnagar, Gujarat were included in this study. Some of the common indications at our hospital for cesarean section were fetal distress, cephalopelvic disproportion, failure of progress of labour, breech presentation, previous cesarean section and failed induction. Informed consent was taken. All the patients were randomly allocated to two groups with 50 women in each group. Group 1 Pfannenstiel incision and Group 2 Misgav Ladach.Results: The duration of surgery, blood loss and post-operative pain were significantly less in the Misgav Ladach group (P<0.001).Conclusions: Misgav Ladach technique of cesarean section has many advantages and should be used routinely.

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

“…Results of the quality assessment of all included studies are shown in Tables S1 and S2. All the randomised control trials judged via the RoB‐2 Tool were found to be of low risk, 10,19–30 or of some concern 31–38 . Similarly, all the observational studies judged via the ROBINS‐I Tool were found to be of low risk, 39–43 or of some concern 44 .…”

“…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).…”

“…All the randomised control trials judged via the RoB-2 Tool were found to be of low risk, 10,[19][20][21][22][23][24][25][26][27][28][29][30] or of some concern. [31][32][33][34][35][36][37][38] Similarly, all the observational studies judged via the ROBINS-I Tool were found to be of low risk, [39][40][41][42][43] or of some concern. 44 Those studies found to be of some concern due to lacking features in the domains of randomisation process, selection of the reported results, or selection of participants.…”

“…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. In the PKM cohort, 2080 patients underwent elective CS 20,[23][24][25][26]28,30,35,39,42 and 1812 patients had emergency CS. 20,23,24,26,28,30,35,39,42 Conversely, in the MMLM and MLM groups, 293 patients 20,24,26,28,42 and 2080 patients 23,25,30,35,39 had elective indications, respectively, while 497 patients 20,24,26,28,42 and 1286 patients 23,30,35,…”