The case records and commentaries in Obsterics and Gynaecology

Abstract

The study was done to evaluate the bene fit 0 l a new proccd ure 0 f caesercan section (Misgav l.adach) introduced in our unit in 1998, by comparing its intra- operative and postopcrati ve outcomes to those 0f rout ine (traditional) caesercan section procedure performed in majority olhospitals in Kenya, This study was justified by the fact that the number and rate or caeserean section is increasing in our hospitals yet facilities and time remain constant. Moreover the techniques used in performing a caeserean section currently have never been validated scientifically, ;\ prospect: vc random ized trial 0 I' 2 14 women undergo ing cacscrean sect ion at Purnwan i Maternity Hospital was carried out: 107 were randomized to the Misgav l.adach group and 107 to the trad i t ional method grou p. The pri nc ipa I investigator performed all the cacsercan sections over one year peri od. Intra-opcrat ive and postopcraii ve outcomes were then recorded, The data was analyzed using statistical package for social sciences (spss/pc+), chi-squire student's t-test and Manu-Whitney u test. Operating and hospital stay time for patients in the new method group was significantly shorter. Surgical consumablcs use and oral analgesics consumption was signi [icantly less for the new method group than in the traditional method group, There \Vas no significant difference between febrile morbidity. wound sepsis, blood loss and tranxfusion requirements between the 2 groups. The incision used lor the new method was found be acceptable to the women who carne Ior review from this treatment group. Patients in the new method group had less postoperative pain on (he second day or operation than those in the traditional method group.

These findings conclusively show that the Misgav Ladach rncthod of cacxcrcan section is as safe ~ISthe traditional method. II \O\<lS noted to reduce operation time by 2X'ij), sutures use was reduced hy 37%, gauze rolls use was reduced by 22°/c), duration 01' hospital SUI)' was reduced by I X%~lIld oral analgesic use was reduced by 20.3%. Though pain assessment was not done lrorn 0-23 hours, the new method was noted to have less post operative pain on the second clay alter operation. As a results or all these it reduces exposure to anaesthetics, reduces the anaesthetist's till1e,?geon's time as "veil as his assistant. ward workload is less and the operated women lincl comfort or breast feeding in a seated position earlier. The new method did not offer significant advantage as far as minimizing wound infections was concerned.