cesarean delivery, surgical technique, evidence-based
Digital Object Identifier (DOI)
Cesarean delivery (CD) is one of the most common major surgeries performed in the United States and worldwide. Surgical techniques evaluated in well-designed randomized controlled trials (RCTs) that demonstrate maternal benefit should be incorporated into practice. The objective of this review is to provide a summary of surgical techniques of the procedure and review the evidence basis for them for the nonobstetrician. The following techniques with the strongest evidence should be commonly performed, when feasible: (1) prophylactic antibiotics with a single dose of ampicillin or first-generation cephalosporin prior to skin incision; (2) postpartum hemorrhage prevention with oxytocin infusion of 10 to 40 IU in 1 L crystalloid over 4 to 8 hours; (3) low transverse skin incision; (4) blunt or sharp subcutaneous and fascial expansion; (5) blunt, cephalad–caudad uterine incision expansion; (6) spontaneous placental removal; (7) blunt-tip needle usage during closure; (8) subcutaneous suture closure (running or interrupted) if thickness is ≥2 cm; and (9) skin closure with suture. Although the number of RCTs designed to optimize maternal and neonatal outcomes of this common procedure is encouraging, further work is needed to minimize surgical morbidity. Optimal methods for postpartum hemorrhage prevention, adhesion prevention, and venous thromboembolism prophylaxis remain ongoing areas of active research, with outcomes that could markedly improve maternal morbidity and mortality. If evidence of a surgical technique appears preferred over another, clinicians should be comfortable adopting the evidence-based technique when performing and teaching CD.
This work is licensed under a Creative Commons Attribution 4.0 License.
Was this content written or created while at USF?
Citation / Publisher Attribution
The Surgery Journal, v. 2, issue 1, p. e1-e6
Scholar Commons Citation
Dahlke, Joshua D.; Mendez-Figueroa, Hector; Sperling, Jeffrey D.; Maggio, Lindsay; Connealy, Brendan D.; and Chauhan, Suneet P., "Evidence-Based Cesarean Delivery for the Nonobstetrician" (2016). Obstetrics & Gynecology Faculty Publications. 11.