A study of various cesarean section techniques at a government tertiary care centre: Misgav Ladach cesarean section versus Pfannenstiel cesarean section

Medha Kanani


Background: It is important to examine every step in any surgery to identify and evaluate its imortance, necessity and purpose with a view to find its better alternatives if they can be found at all. The most appropriate surgical procedure is the one which takes minimum time to be complete, simplest to perform, causing least damage and least complication for the patient. Present study was undertaken to assess the benefits of the Misgav Ladach cesarean section technique in comparison to the conventional Pfannenstiel technique in the tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative pain and post-operative stay in hospital.

Methods: All the women posted for emergency cesarean section in the Obstetrics OT at Sir T Hospital, Bhavnagar, Gujarat were included in this study. Some of the common indications at our hospital for cesarean section were fetal distress, cephalopelvic disproportion, failure of progress of labour, breech presentation, previous cesarean section and failed induction. Informed consent was taken. All the patients were randomly allocated to two groups with 50 women in each group. Group 1 Pfannenstiel incision and Group 2 Misgav Ladach.

Results: The duration of surgery, blood loss and post-operative pain were significantly less in the Misgav Ladach group (P<0.001).

Conclusions: Misgav Ladach technique of cesarean section has many advantages and should be used routinely.


Cesarean section, Misgav Ladach, Pfannenstiel

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Chitra K, Nirmala AP, Gayetri R, Jayanthi AV, Shanthi S. Misgav Ladach Cesarean Section vs Pfannenstiel Cesarean Section. J Obstet Gynecol India. 2004;54(5):473-7.

Timonen S, Castren O, Kivalo I. Caesarean section. Low transverse (Pfannenstiel) or low midline incision? Ann Chir Gynaecol Fenn. 1969;59:173-6.

Stark M. Technique of Caesarean section: the Misgav - Ladach method. In: Popkin DR, Peddle LJ. eds. Women's health today. perspectives on current research and clinical practice. Proceedings of the 14th World Congress on Gynecology and Obstetrics. London. Partheneon. 81-5.

Tucker JM, Hauth JC, Hodgkins P. Trial of labour after a one or two layer closure of a low transverse uterine incision. Am J Obstet Gynecol. 1993;168:545-6.

Chamberlain G. Caesarean Section. In Chamberlain G, Steer P, editors. Turnbull’s Obstetrics, 3rd ed. London: Harcourt Publishers;2001:612.

Heys SD, Goughd, Steele RJ. The Gastrointestinnal system: The peritoneum. In Eremin O, editor. The scientific and clinical basis of surgical practice. 1st ed. Nottingham Oxford University Press;2001:246.

Sjoholm L, Holmgren G. The Misgav Ladach method of cesarean section: evolved by Joel Cohen and Michael Stark in Jerusalem. Trop Doct. 1996;26:160

National Collaborating Centre for Women’s and children’s health (UK) Caesarean section. RCOG press; London:2011.

Roberge S, Chaillet N, Boutin A, Moore L, Jastrow N, Brassard N, et al. Single-versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynecol Obstet. 2011;115(1):5-10.

Glavind J, Madsen LD, Uldbierg N, Dueholm M. Ultrasound evaluation of Cesarean scar after single-and double-layer uterotomy closure: a cohort study. Ultrasoun Obstet Gynecol. 2013;42:207-12.

Bujold E, Goyet M, Marcoux S, Brassard N, Cormier B, Hamilton E, et al. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol. 2010;116(1):43-50.