Absorbable staples for uterine incision at caesarean section

Staples can be placed during the making of an incision, with the aim of decreasing blood loss from the cut edges.

The objective of this review was to assess the effects of using a stapler with absorbable staples to extend the uterine incision at lower segment caesarean section.

We searched the Cochrane Pregnancy and Childbirth Group trials register.

Randomised and quasi-randomised trials of extending the uterine incision using a stapler compared with extending the incision digitally or with scissors in women having a lower segment transverse incision caesarean section.

Eligibility and trial quality were assessed.

Four trials involving 526 women were included. There was no difference in total operating time between the stapling technique and other techniques to extend the incision (weighted mean difference -1.17 minutes, 95% confidence interval -3.57 to 1.22). However stapling devices increased the time needed to deliver the baby (weighted mean difference 0.85 minutes, 95% confidence interval 0.48 to 1.23). Blood loss was lower with the use of staples (weighted mean difference -41.22 millilitres, 95% confidence interval -50.63 to -31.8). No significant differences between stapling and other techniques were detected for other perinatal morbidity outcomes.

There is not enough evidence to justify the routine use of stapling devices to extend the uterine incision at lower segment caesarean section. There is a possibility that stapling could cause harm, by prolonging the time to deliver the baby.