Evidence-based cesarean delivery guidelines

Slideshow

Review the steps in a cesarean and take a moment to examine the best available evidence for performing the procedure.

Cesarean section is the most commonly performed surgical procedure in the United States, with nearly 1.3 million cases performed each year, approximately 32% of all deliveries.1 The purpose of this article is to review the steps in a cesarean delivery and examine the best available evidence for performing the procedure.

References:

1. Martin JA, Hamilton BE, Osterman MJ. Births in the United States, 2015. Natl Center Health Stat Data Br. 2016;2015:1-8. 2. Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol. 2004;May103(5 Pt 1):907-12.3. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2012 Feb 20;2:CD004985.4. Huang H, Li G, Wang H, He M. Optimal skin antiseptic agents for prevention of surgical site infection in cesarean section: a meta-analysis with trial sequential analysis. J Matern Fetal Neonatal Med. 2017;Aug 30:1-8.5. Tuuli MG, Liu J, Stout MJ, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med. 2016;374(7):1-9.6. Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2014;Dec 21(12CD007892).7. Caissutti C, Saccone G, Zulio F, et al. Vaginal cleansing before cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(3):527-538. 8. ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011;117(6):1472-83. 9. Tita AT, Szychowski JM, Boggess K, et al and C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2015;375(13):1231-41.10. Skeith AE, Niu B, Valent AM, Tuuli MG, Caughey AB. Adding azithromycin to cephalosporin for cesarean delivery infection prophylaxis: a cost-effectiveness analysis. Obstet Gynecol. 2017;130(6):1279-84.11. Wallin G, Fall O. Modified Joel-Cohen technique for caesarean delivery. BJOG. 1999;106:221-226.12. Mathai M, Hofmeyr GH, Mathai NE. Abdominal surgical incisions for caesarean section. Cochrane Syst Rev. 2013;May 31;(5):CD004453. 13. Tuuli MG, Odibo AO, Gogertey P, Roehl K, Stamilio D, Macones GA. Utility of the bladder flap at cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2012;119(4):815-21. 14. Magann EF, Chauhan SP, Bufkin L, Field K, Roberst WE, Martin JN Jr. Intra-operative Haemorrhage by blunt versus sharp expansion of the uterine incision at cesarean delivery: a randomized clinical trial. BJOG. 2002;109(4):448-52.15. Cromi A, Ghezzi F, Di Naro E, Siesto G, Loverro G, Bolis P. Blunt expansion of the low transverse uterine incision at cesarean delivery: a randomized comparison of 2 techniques. Am J Obstet Gynecol. 2008;199(3):292 e1-6.16. Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD004737.17. Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of cesarean section. Cochrane Database Syst Rev. 2014 Jul 22;(7):CD004732.18. Gyamfi C, Juhasz G, Gyamfi P, Blumenfeld Y, Stone JL. Single- versus double-layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med. 2006;19(10):639-43. 19. Roberge S, Chaillet N, Boutin A, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet. 2011;115(1):5-10.20. Lyell DJ, Caughey AB, Hu E, Daniels K. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol. 2005;106(2):275-80. 21. Kapustian V, Anteby EY, Gdalevich M, Shenhav S, Lavie O, Gemer O. Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study. Am J Obstet Gynecol. 2012;206(1):56.e1-4. 22. Kiefer DG, Muscat JC, Santorelli J, et al. Effectiveness and short-term safety of modified sodium hyaluronic acid-carnoxymethylcellulose at cesarean delivery: a randomized trial. Obstet Gynecol. 2016;214(3):373.e1-373.e12.23. Gaspar-Oishi M Aeby T. Cesarean delivery times and adhesion severity associated with prior placement of a sodium hyaluronate-carboxycellulose barrier. Obstet Gynecol. 2014;124(4):679-83.24. Chelmow D, Rodriguez EJ, Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol. 2004;103(5 Pt 1):974-80.25. Ramsey PS, White AM, Guinn DA, et al. Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing a cesarean delivery. Obstet Gynecol. 2005;105(5 Pt 1):967-73.26. Figueroa D, Jauk VC, Szychowski JM et al. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2013;121(1):33-8.27. Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean section: a metaanalysis. Am J Obstet Gynecol. 2015;212(5):621.e1-10.28. Buresch AM, Van Arsdale A, Ferzli, M, et al. Comparison of subcuticular suture type for skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2017;130(3):521-26. 29. Yu L, Kronen RJ, Simon LE, Stoll CRT, Colditz GA, Tuuli MG. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;Sep 23.pii: S0002-9378(17)31132-8.[Epub ahead of print].

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