Perinatal Outcomes in Extra vs. Transperitoneal Cesarean Delivery: A Systematic Review and Meta-Analysis of...

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Observational studies suggest benefits of extraperitoneal cesarean delivery (EPCD), but high-quality evidence is limited.
• Previous studies on EPCD have involved small participant numbers, necessitating robust comparative analysis.
• This study addresses the need for accurate evidence on EPCD versus transperitoneal CD (TPCD) outcomes.

Purpose of the Study:

• To compare intraoperative and postoperative maternal and neonatal outcomes between EPCD and TPCD.
• To evaluate the safety and efficacy of EPCD based on randomized controlled trial (RCT) data.
• To provide evidence-based insights into the clinical utility of EPCD.

Main Methods:

• A systematic review and meta-analysis of RCTs comparing EPCD and TPCD, searched across six databases up to August 2025.
• Inclusion criteria focused on peer-reviewed RCTs directly comparing the two cesarean delivery techniques.
• Study quality was assessed using the Cochrane Risk of Bias tool, with Apgar score and postoperative pain as primary outcomes.

Main Results:

• Seven RCTs with 758 women were included; 1-min Apgar data were insufficient.
• Five-minute Apgar scores were comparable (p=0.91), but umbilical artery pH < 7.2 was higher in EPCD (7.9% vs. 2.3%, p=0.047).
• EPCD demonstrated significantly lower postoperative pain at 24h (p<0.001) and shorter time to first gas passage (7.4h vs. 14.7h, p<0.001) compared to TPCD.

Conclusions:

• While EPCD offers maternal benefits like reduced pain and faster recovery, neonatal safety requires further rigorous investigation.
• The increased incidence of low umbilical artery pH in the EPCD group warrants careful consideration.
• Further research is needed to clarify the neonatal implications of EPCD before widespread adoption.