Intervention Review
Abdominal surgical incisions for caesarean section
Editorial Group: Cochrane Pregnancy and Childbirth Group
Published Online: 8 JUL 2009
Assessed as up-to-date: 6 NOV 2006
DOI: 10.1002/14651858.CD004453.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Mathai M, Hofmeyr GJ. Abdominal surgical incisions for caesarean section. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004453. DOI: 10.1002/14651858.CD004453.pub2.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 8 JUL 2009
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 (30 April 2006).
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 were included in this review.
Two studies (411 participants) compared the Joel-Cohen incision with the Pfannenstiel incision. Overall, there was a 65% reduction in reported postoperative morbidity (relative risk (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 (weighted mean difference (WMD) -11.40, 95% CI -16.55 to -6.25 minutes); delivery time (WMD -1.90, 95% CI -2.53 to -1.27); total dose of analgesia in the first 24 hours (WMD -0.89, 95% CI -1.19 to -0.59); estimated blood loss (WMD -58.00, 95% CI -108.51 to - 7.49 ml); postoperative hospital stay for the mother (WMD -1.50, 95% CI -2.16 to -0.84); and increased time to the first dose of analgesia (WMD 0.80, 95% CI 0.12 to 1.48) compared to 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 participants) 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 (WMD 0.40 days, 95% CI -0.34 to 1.14).
Authors' conclusions
The Joel-Cohen incision has advantages compared to 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.
Plain language summary
Abdominal surgical incisions for caesarean section
In a caesarean section operation, there are various types of incisions in the abdominal wall that can be used. These include vertical and transverse incisions, and there are variations in the specific ways the incisions can be undertaken. The review of studies identified 4 trials involving 666 women. The Joel-Cohen incision showed better outcomes than the Pfannenstiel incision in terms of less fever for women, less postoperative pain, less blood loss, shorter duration of surgery and shorter hospital stay. However, the trials did not assess possible long-term problems associated with different surgical techniques.
摘要
背景
剖腹產的腹部手術切口
剖腹產是全球婦女最常進行的手術。腹部切口手術技術各異，其中一些技術已經透過隨機試驗做過評估。
目標
確認剖腹產之腹部手術，各種不同切口方式之好處與風險。
搜尋策略
我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2006年4月30日)。
選擇標準
納入進行各種腹部切口的剖腹產的隨機控制試驗(Randomised controlled trials)。
資料收集與分析
我們從來源摘錄資料，檢視它們的準確度並分析資料。
主要結論
此次回顧納入4篇研究。有2篇研究(411名研究對象)比較JoelCohen式切口與Pfannenstiel式切口。整體而言，比起Pfannenstiel式切口，JoelCohen式切口的術後發病率減少65% (RR為0.35, 95% CI為0.14 .87)。其中1篇試驗指出，相較於Pfannenstiel式切口，JoelCohen式切口減少術後止痛需求(RR為0.55, 95% CI為0.40 – 0.76)；手術時間減少(加權平均差(weighted mean difference (WMD))為 −11.40, 95% CI為 −16.55 至 −6.25分鐘)；分娩時間減少(WMD為 −1.90, 95% CI為 −2.53至−1.27)；最初24小時的總止痛藥劑量減少(WMD為 −0.89, 95% CI為 −1.19至−0.59)；估計失血量減少(WMD為−58.00, 95% CI為 −108.51至 −7.49 ml)；產婦術後住院天數減少(WMD為 −1.50, 95% CI為 −2.16至−0.84)；第1次使用止痛藥的時間延後(WMD為0.80, 95% CI為0.1 1.48)。除了以上情況，這2篇試驗未發現其他顯著差異。另有2篇研究把肌肉切割切口法與Pfannenstiel式切口比較。其中第1篇研究(68名婦女)比較Mouchel式切口和Pfannenstiel式切口，但無資料可供此次回顧使用。其中第2篇研究(97名研究對象)比較Maylard肌肉切割切口和Pfannenstiel式切口，指出發燒之罹病率沒有差異(RR為1.26, 95% CI為0.08 – 19.50)；輸血需求也無差異(RR為0.42, 95% CI為0.02 – 9.98)；傷口感染也無差異(RR為1.26, 95% CI為0.27 – 5.91)；術後3個月的肌肉活力檢測，和術後住院天數(WMD為0.40天, 95% CI為−0.34至1.14)也無差異。
作者結論
JoelCohen式切口優於Pfannenstiel式切口。比較少發燒、少疼痛且較少需要止痛藥；失血量少；手術期間短且住院天數減少。產婦的這些好處可以節省健康照護體系之費用。不過，這些試驗未提供有關嚴重或長期罹病和死亡的資料。
翻譯人
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
總結
剖腹產時的腹部切口。 剖腹產手術時，使用的腹壁切口型式相當多，包括垂直切口與橫向切口，進行切口的特定方法相當多。本回顧共確認了4篇研究、666名婦女。JoelCohen式切口的結果優於Pfannenstiel式切口，婦女們較少發燒、術後疼痛較少、失血量少、手術期間短且住院天數減少。不過，這些試驗並未評估各種手術技術可能的長期問題。