Joel-Cohen or Pfannenstiel Incision at Cesarean Delivery: Does it Make a Difference?

Abstract

This study attempted to show whether the technique used to open the abdomen at cesarean delivery affects operating time and maternal and neonatal outcomes. Consecutive women having cesarean section at 32 weeks' or more gestational age were randomly assigned to have either a Pfannenstiel incision (about 2 cm above the pubic symphysis with its mid-portion within the shaved area of the pubis) or a Joel-Cohen incision (about 3 cm below the line joining the anterior superior iliac spines and approximately 17 cm long). The latter is part of the Misgav Ladach method of cesarean section. Women having two or more previous sections or a previous longitudinal incision were excluded. All participants were older than 18 years of age and had a singleton pregnancy. The Pfannenstiel incision was used in 158 patients and the Joel-Cohen incision in 152. Total operating time was similar in the two groups, approximating just over 30 minutes. Extraction times from skin incision to clamping of the cord were shorter in the Joel-Cohen group (190 vs. 240 seconds). This difference persisted after adjusting for general anesthesia, surgery by a junior surgeon, and previous section delivery. There were no group differences in intraoperative or postoperative complications, Apgar scores, or admission to neonatal intensive care. Neurodevelopmental assessments at age 6 months showed no incision-related differences. This study does not warrant recommending a Joel-Cohen incision rather than a Pfannenstiel incision for cesarean section, even though the fetus is delivered somewhat more rapidly.