Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean section? A randomised controlled trial.

Abstract

OBJECTIVE:

The objective was to determine the benefit of non-dissection of the rectus sheath inferiorly in a Pfannenstiel incision during an elective Caesarean section with regard to operative blood loss and post-operative pain.

DESIGN:

A randomised controlled trial.

SETTING:

The Royal Free Teaching Hospital in London.

POPULATION:

One hundred and twenty women who underwent elective Caesarean section delivery.

METHOD:

Women were randomised to have dissection or non-dissection of the rectus sheath inferiorly during an elective Caesarean section.

MAIN OUTCOME MEASURES:

Estimated blood loss during the operation, as well as the difference between pre- and post-operative haemoglobin levels. Post-operative pain was assessed by the visual analogue scale, a verbal rating scale and the use of post-operative analgesia. Patient satisfaction was assessed by a verbal rating scale.

RESULTS:

There was no significant difference in the estimated blood loss during the procedure between the two groups; however, the mean difference between the pre-operative and post-operative haemoglobin was significantly smaller in the study group (p=0.05). There was a statistically significant difference in both the visual analogue scale (p-value=0.03) and the verbal rating scale scores (p-value=0.02) for pain between the two groups, with lower scores for the study group. There was no overall difference in the verbal rating scale scores for patient satisfaction.

CONCLUSION:

Non-dissection of the rectus sheath inferiorly in Pfannenstiel incisions during Caesarean section procedures is associated with a significant reduction in the post-operative pain as well as a smaller drop in post-operative haemoglobin.

• Authors: Rezan A Kadir, Aalia Khan, Florence Wilcock, Lynne Chapman
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) 2006 Sep-Oct Vol. 128 Issue 1-2 Pg. 262-6 ISSN: 0301-2115 [Print] Ireland
• PMID: 16621227 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Blood Loss, Surgical (prevention & control)
• Cesarean Section (adverse effects, methods, rehabilitation)
• Dissection (adverse effects, methods, rehabilitation)
• Female
• Humans
• Pain, Postoperative
• Pregnancy
• Rectus Abdominis (surgery)