Evidence-based cesarean technique

Abstract

Cesarean section is the most common surgical procedure performed on US women, and rates of cesarean delivery continue to increase. Recent studies on operative technique in cesarean section have contributed significantly to our knowledge of antibiotic prophylaxis, bladder flap formation, management of the uterine repair and closure of the peritoneum and skin. There is compelling evidence that antibiotics should be given prior to skin incision rather than the traditional administration after cord clamping. Additionally, evidence suggesting benefit to multiagent, extended-coverage regimens is mounting. Recent studies challenge the accepted practice of creating a bladder flap in cesarean section. Uterine repair can be safely accomplished either intra or extraabdominally but the debate over single versus double-layer closure continues. Nonclosure of the visceral peritoneum confers significant benefit, but recent evidence suggests that closure of the parietal layer may be advantageous with respect to future adhesions. It is imperative that all technical aspects in cesarean section continue to be challenged. Widely accepted aspects, including antibiotics administration at cord clamping and creation of a bladder flap, may not be best practice.