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Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean
Rezan A Kadir1, Aalia Khan, Florence Wilcock
1Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom. rezan.abdul-kadir@royalfree.nhs.uk
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.
