Study on modification of the Misgav Ladach method for cesarean section versus the Pfannenstiel technique

ABSTRACT

To evaluate the operative and postoperative outcomes of two different methods of cesarean section, and to determine whether the modified Misgav Ladach Technique can offer benefits when compared with the conventional Pfannenstiel cesarean section. In this prospective randomized controlled study, 80 women undergoing a first elective or emergency cesarean section were randomly allocated to two groups. One group [n=40] was operated on by the modified Misgav Ladach method for cesarean section and the other group [n=40] by the Pfannenstiel method. The modified points in the Misgav Ladach method included transversely incising the subcutaneous tissue and rectus sheath 2 to 3 cm then dividing them bluntly, two layers suturing of low transverse uterine incision; closing the skin by staples. Outcome measures studied were operating time, time to newborn delivery, amount of intraoperative blood loss, analgesics required in the first postoperative day, bowel restitution by the second postoperative day, febrile morbidity, postpartum endometritis, wound infection and hospitalization period. Operating time was significantly different between the two methods, with an average of 26.4 minutes with the modified Misgav Ladach method and 39.8 minutes with the Pfannenstiel method [p<0.05]. Time to newborn delivery was with average 1.2 minutes with the modified Misgav Ladach method and 3.9 minutes with the Pfannenstiel method [p<0.05]. The amount of intraoperative blood loss differed significantly, with 388 ml and 555 ml respectively [p<0.05]. Significantly less analgesic doses were needed after the modified Misgav Ladach method. Proportion of cases who had bowel restitution by the second postoperative day was significantly higher in the modified Misagav Ladach group. There was no significant difference between the two groups regarding febrile morbidity, endometritis, wound infection and period of hospitalization. The modified Misgav Ladach method of cesarean section has advantages over the Pfannenstiel technique by being significantly quicker to perform, faster in delivering the newborn, with more reduction of intraoperative blood loss, lesser need for analgesia and earlier bowel restitution. In this study no negative effects of the modified Misgav Ladach method were found