Caesarean section -- no consensus on best technique

July 15, 2008

Despite the routine delivery of babies by caesarean section, there is no consensus among medical practitioners on which is the best operating method to use. In a systematic review published in The Cochrane Library, researchers call for further studies to establish the safest method for both mother and infant.

"Caesarean section is a very common operation, yet there is a lack of high quality information available to inform best practice," says researcher Simon Gates of the Clinical Trials Unit at the University of Warwick.

Techniques used during caesarean section operations depend largely on the preferences of individual surgeons. Their personal preference can affect the length of the operation, amount of blood lost, risk of infection and the level of pain experienced by a woman following surgery.

The review includes 15 trials that together involved 3,972 women. Although results from several of these trials suggest that single layer closure of the uterus after delivery reduces blood loss and operation times compared to double layer closure, there was no information on other important outcomes such as infection and subsequent complications. The researchers found only very limited data on incision techniques and instruments, as well as methods used to close the uterus. They were therefore unable to make recommendations as to the most appropriate surgical procedure.

"Future research on Caesarean techniques needs to focus on the most suitable methods for uterine incision and closing. We need more high quality studies that address the most important outcomes such as pain, infections and complications" says Gates.
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Wiley

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