Evidence-based cesarean delivery guidelines


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.


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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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