title: Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean section? A randomised controlled trial.
abstract: OBJECTIVE
  The objective was to determine the benefit of non-dissection of the rectus sheath inferiorly in a Pfannenstiel incision during an elective Caesarean section with regard to operative blood loss and post-operative pain.
  
  
  METHODS
  A randomised controlled trial.
  
  
  METHODS
  The Royal Free Teaching Hospital in London.
  
  
  METHODS
  One hundred and twenty women who underwent elective Caesarean section delivery.
  
  
  METHODS
  Women were randomised to have dissection or non-dissection of the rectus sheath inferiorly during an elective Caesarean section.
  
  
  METHODS
  Estimated blood loss during the operation, as well as the difference between pre- and post-operative haemoglobin levels. Post-operative pain was assessed by the visual analogue scale, a verbal rating scale and the use of post-operative analgesia. Patient satisfaction was assessed by a verbal rating scale.
  
  
  RESULTS
  There was no significant difference in the estimated blood loss during the procedure between the two groups; however, the mean difference between the pre-operative and post-operative haemoglobin was significantly smaller in the study group (p=0.05). There was a statistically significant difference in both the visual analogue scale (p-value=0.03) and the verbal rating scale scores (p-value=0.02) for pain between the two groups, with lower scores for the study group. There was no overall difference in the verbal rating scale scores for patient satisfaction.
  
  
  CONCLUSIONS
  Non-dissection of the rectus sheath inferiorly in Pfannenstiel incisions during Caesarean section procedures is associated with a significant reduction in the post-operative pain as well as a smaller drop in post-operative haemoglobin.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom. rezan.abdul-kadir@royalfree.nhs.uk
authors.forename: Rezan A
authors.initials: RA
authors.lastname: Kadir
authors.forename: Aalia
authors.initials: A
authors.lastname: Khan
authors.forename: Florence
authors.initials: F
authors.lastname: Wilcock
authors.forename: Lynne
authors.initials: L
authors.lastname: Chapman
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D004210:Dissection / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D010149:Postoperative Pain; D011247:Pregnancy; D017568:Rectus Abdominis / Q000601:surgery*