Evidence-based surgery for cesarean delivery

Objective The purpose of this study was to provide evidenced-based guidance for surgical decisions during cesarean delivery. Study design We performed MEDLINE, PubMed, EMBASE, and COCHRANE searches with the terms cesarean section, cesarean delivery, cesarean, pregnancy, randomized trials, and each technical aspect of cesarean delivery. All randomized trials that covered a surgical aspect of cesarean delivery were included in the review. Each surgical step of cesarean delivery was reviewed separately. Results US Preventive Services Task Force recommendations favor blunt uterine incision expansion, prophylactic antibiotics (either ampicillin or first-generation cephalosporin for just 1 dose), spontaneous placental removal, non-closure of both visceral and parietal peritoneum, and suture closure or drain of the subcutaneous tissue when thickness is ≥2 cm. Conclusion Cesarean delivery techniques that are supported by good quality recommendations should be performed routinely. All technical aspects that have recommendations with lower quality should be researched with adequately powered and designed trials.