Misgav‐Ladach or modified Misgav‐Ladach versus Pfannenstiel‐Kerr methods for cesarean deliveries: A systematic review and meta‐analysis

• Published in: Reproductive, female and child health female and child health, 2023-12, Vol.2 (4), p.287-300
• Main Authors: Bourdakos, Natalie E., Abdulsalam, Fatma A. M., Macaron, Marie Michele, Nasser, Maya L., Yap, Nathanael, Matar, Reem H., Adra, Maamoun, Nakanishi, Hayato, Than, Christian A., Arulkumaran, Sir Sabaratnam
• Format: Article
• Language: English
• Subjects: Abdomen; caesarean section; Cesarean section; C‐section; Joel‐Cohen; Methods; Misgav‐Ladach; Pfannenstiel; Placenta; Software; Stark; Surgeons; Surgical outcomes; Sutures; Uterus
• ISSN: 2768-7228; 2768-7228
• DOI: 10.1002/rfc2.65

Background Caesarean sections (CSs) constitute a large proportion of fetal deliveries, yet no consensus exists on optimal surgical method. Objectives To investigate the safety and efficacy of the Pfannenstiel‐Kerr method (PKM) in comparison to Misgav‐Ladach method (MLM) and Modified Misgav‐Ladach method (MMLM) for CS. Search Strategy Cochrane, Embase, PubMed, CiNAHL, Scopus, and Web of Science were searched from database inception to March 2023. Selection Criteria Prospective studies comparing MLM with PKM or MMLM with PKM. Data Collection and Analysis Three authors independently conducted data extraction and assessed quality. Pooled means and proportions were analyzed using inverse variance and Mantel‐Haenszel methods. Main Results Twenty‐seven studies with 15 251 patients, met the selection criteria. Both MLM (mean difference [MD]: −12.09 min, 95% confidence interval [CI]: −14.40, −9.77, Tau2 = 16.79, I2 = 97%), (MD: −125.98 mL, 95% CI: −172.13, −79.83, Tau2 = 3458.59, I2 = 87%) and MMLM (MD: −11.38 min, 95% CI: −14.72, −8.04, Tau2 = 30.56, I2 = 100%), (MD: −62.61 mL, 95% CI: −103.13, −22.09, Tau2 = 1451.35, I2 = 92%) demonstrated shorter operative time and decreased blood loss, respectively, compared to PKM. Similarly, both MLM (MD: −1.70 min, 95% CI: −2.26, −1.14, Tau2 = 0.51, I2 = 97%), (MD: −0.77 d, 95% CI: −1.35, −0.19, Tau2 = 0.60, I2 = 98%) and MMLM (MD: −2.80 min, 95% CI: −3.89, −1.70, Tau2 = 1.74, I2 = 100%), (MD: −0.58 d, 95% CI: −1.00, −0.17, Tau2 = 0.29, I2 = 100%) demonstrated shorter fetal extraction time and length of hospital stay, respectively, compared to PKM. Conclusions MLM and MMLM should be considered safe and effective alternative approaches to CSs. Tweetable A meta‐analysis of 27 trials found that in comparison to the Pfannenstiel‐Kerr method, the Misgav‐Ladach and Modified Misgav‐Ladach methods should be considered safe and effective alternative approaches to cesarean section.