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Abstract

Thank you for the comments on our systematic review of randomized trials of various methods of cesarean section.1Hofmeyr J.G. Novikova N. Mathai M. Shah A. Techniques for cesarean section.Am J Obstet Gynecol. 2009; 201: 431-444Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar We agree that the operating times reported for the various methods studied in the randomized trials appear long, compared with our experience. What is of importance is the comparisons of the time taken for different methods under similar circumstances in randomized trials. The Misgav-Ladach method was significantly faster than other methods, using a single layer locking continuous suture similar to that described by the author for his first layer. There is observational study evidence that a second layer, as described by Gyamfi et al, may reduce the risk of scar dehiscence in subsequent pregnancies,2Gyamfi C. Juhasz G. Gyamfi P. Blumenfeld Y. Stone J.L. Single- versus double-layer uterine incision closure and uterine rupture.J Matern Fetal Neonatal Med. 2006; 19: 639-643Crossref PubMed Scopus (40) Google Scholar although this has not been studied in randomized trials. Thank you for the comments on our systematic review of randomized trials of various methods of cesarean section.1Hofmeyr J.G. Novikova N. Mathai M. Shah A. Techniques for cesarean section.Am J Obstet Gynecol. 2009; 201: 431-444Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar We agree that the operating times reported for the various methods studied in the randomized trials appear long, compared with our experience. What is of importance is the comparisons of the time taken for different methods under similar circumstances in randomized trials. The Misgav-Ladach method was significantly faster than other methods, using a single layer locking continuous suture similar to that described by the author for his first layer. There is observational study evidence that a second layer, as described by Gyamfi et al, may reduce the risk of scar dehiscence in subsequent pregnancies,2Gyamfi C. Juhasz G. Gyamfi P. Blumenfeld Y. Stone J.L. Single- versus double-layer uterine incision closure and uterine rupture.J Matern Fetal Neonatal Med. 2006; 19: 639-643Crossref PubMed Scopus (40) Google Scholar although this has not been studied in randomized trials. The fifteen minute cesarean deliveryAmerican Journal of Obstetrics & GynecologyVol. 203Issue 2PreviewHofmeyr et al1 wrote a very interesting comparison of the various techniques for performing a cesarean delivery. However, I was struck by the operating times, which, with 1 exception,2 range from 27.5 to 56.5 minutes. The one exception (the Misgav Ladach technique) involves a good deal of finger dissection, which I find awkward, and only a single-layer uterine closure. It is possible to do a cesarean delivery in 15 minutes without rushing and to include a double-layer uterine closure and a subcuticular skin closure. Full-Text PDF