Comparison between the use of the Joel-Cohen incision and its modification during Stark's cesarean section

Abstract

Objective. A comparative evaluation between the Joel-Cohen incision and its modification for the Stark's cesarean section (CS).

Materials and methods. In a retrospective study, 477 women who underwent a Stark's CS were evaluated: 204 with the Joel-Cohen incision (JC) and 273 with a modified Joel-Cohen incision (MJC). All patients were checked for the following parameters: febrile morbidity, the need for painkillers, duration of hospital stay, and ultrasound examination for blood collection (BC) on the third postoperative day. The collections, when diagnosed were divided into three groups: (1) in the abdominal wall, (2) in the pouch of Douglas, and (3) in the lower uterine segment (LUS). Those included in the study were low-risk primiparae at term, presenting for CS for breech presentation, macrosomia, and on demand, and who had combined spinal–epidural anesthesia. Statistical evaluation was performed using SAS/V12 software.

Results. There were no statistical differences between the two groups with regard to febrile morbidity, duration of need for painkillers, and hospital stay. Statistically more blood collections were found in the MJC incision group (5.4% in the abdominal wall, 12.4% in the pouch of Douglas, and 11.7% in the LUS) than in the classical JC incision group (3.9% in the abdominal wall, 10.2% in the pouch of Douglas, and 8.8% in the LUS), however without any clinical significance.

Conclusions. The routine use of the classical JC incision during the Stark's CS seems to be more rational, and causes fewer blood collections.

Keywords:

• Joel-Cohen incision
• Stark's cesarean section
• ultrasonography