title: Sharp compared with blunt fascial incision at cesarean delivery: a randomized controlled trial with each case as her own control.
abstract: OBJECTIVE
  To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control.
  
  
  METHODS
  Women undergoing primary cesarean delivery (n=34) were randomized to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic regression. The secondary outcome was difference in pain between the two sides measured on a 0.0-10.0 numerical rating scale at 1, 3, and 7 days and 1 and 3 months postoperatively. Pain scores were analyzed with a Wilcoxon signed rank test.
  
  
  RESULTS
  28 cases were analyzed and no significant difference was found in preference after three months. Nine women preferred the sharp (32%, 95% CI 16-52%) and 7 the blunt side (25%, 95% CI 11-45%) (P=0.804). Pain scores did not differ significantly between the two sides at any time postoperatively either at rest or during mobilization.
  
  
  CONCLUSIONS
  No significant difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores.
  
  
  BACKGROUND
  ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725.
authors.affiliation: Department of Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, Denmark. Electronic address: anae@regionsjaelland.dk.
authors.forename: Anna J M
authors.initials: AJ
authors.lastname: Aabakke
authors.affiliation: Department of Obstetrics and Gynecology, University of Copenhagen, Hvidovre Hospital, Denmark.
authors.forename: Kristine J
authors.initials: KJ
authors.lastname: Hare
authors.affiliation: Department of Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Krebs
authors.affiliation: The Research Unit Women's and Children's Health, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Secher
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D002921:Cicatrix / Q000523:psychology*; D004311:Double-Blind Method; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D010149:Postoperative Pain; D057240:Patient Preference; D011247:Pregnancy; D013530:Surgical Wound Infection; D016896:Treatment Outcome
keywords: Cesarean delivery; Fascia; Pain; Postoperative; Randomized controlled trial