Considerations about caesarian section technique - evidence based (Cochrane)

A.D. Stănescu, R.M. Sima, L. Pleș

Rezumat: Introduction. Caesarean section is the most common major surgery. Since the first time reported in literature, in 1610, caesarean surgical technique greatly improved. Material and method. We checked medical databases, international randomized trials, meta-analyzes, COHRANE studies on current techniques of caesarean section. Results. Data based on technical evidence on caesarean section sums up the following recommendations. Antibiotic prophylaxis with ampicillin, or with I generation cephalosporins is indicated with 15-60 minutes before skin incision, reducing postpartum endometritis risk. Thromboprophylaxis is reported in a few studies and is not routinely recommended. Vaginal poliiodine preoperative solutions were shown to reduce the incidence of endometriosis. Bladder catheterization is associated with a low rate of urinary tract infections if removed within 24 hours after surgery. Analyzing the Pfannenstiel-Kerr, Joel Cohen, Misgav Ladach, and modified Misgav Ladach techniques, it was observed that the uterine incision with minimal bleeding is blunt cranio-caudal dissection. It is indicated the spontaneous placental removal, and the uterus externalization is based on the surgeon’s preference. Uterine closure can be made single layer unless fertility is preserved. Prevention of postpartum haemorrhage is indicated using Oxytocin (10-40 IU/l crystalloid solution in 4-8 hours). Supplementary oxygen therapy, dilating the cervical canal and subcutaneous drainage are not recommended. Conclusions. Caesarean section is a surgical procedure with an increasing incidence, leading to the progression of technology and shortening the time of realization.
Cuvinte cheie: Pfannenstiel-Kerr, Joel Cohen, Misgav Ladach, and modified Misgav Ladach.