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Rectus muscle reapproximation at cesarean delivery: a randomized controlled trial
Berna Aslan Cetin1, Fitnat Topbas2, Kübra Keskin Toptas1
1Başakşehir Cam and Sakura City Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
Objective:
The aim of our study was to investigate the effect of rectus muscle reapproximation at cesarean delivery (CD) on postoperative pain and rectus muscle diastasis.
Methods:
Our study was planned as a prospective, randomized study in our clinic between December 2019 and March 2021. The study group included women >37 weeks of gestation, undergoing CD for the first time, with no prior history of pelvic or abdominal surgery, 18-40 years of age. Patients were randomly assigned to either the rectus muscle reapproximation group or the control group. Patients were evaluated at postoperative 1st day and 6th week. The primary outcome was the comparison of the Visual Analogue Scale (VAS) score and inter-rectus diatance (IRD) among the groups. Additionally, factors associated with rectus diastasis were also analyzed using logistic regression.
Results:
A total of 306 women undergoing primary cesarean sections were randomized, and 296 were included in the final analysis. There was no significant difference in terms of VAS score and postoperative analgesia need among the groups. IRD 2 cm below umbilicus was significantly shorter in rectus muscle reapproximation group at postoperative 6th week. The logistic regression analysis showed that rectus muscle reapproximation had a negative impact on the development of rectus diastasis below umbilicus (OR = 2.830, p = 0.013).
Conclusion:
Rectus muscle reapproximation during CD resulted in less rectus diastasis below umbilicus. On the other hand it did not affect postoperative VAS score.
