Evidence-based Analysis of Primary Caesarean Section Techniques Amongst Obstetricians: A Questionnaire-based Cross-sectional Study

Abstract

Introduction: Caesarean Section (CS) despite being one of the most commonly performed surgeries in the world has a wide variation in its techniques. To improve the outcomes of CS through rectification of the surgical techniques, it is imperative to assess the current practices amongst the obstetricians and analyse the rationale behind their surgical preferences. Aim: To assess the surgical techniques used for primary CS by obstetricians and review them with respect to the current evidence. Materials and Methods: The present descriptive, questionnairebased, cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Mayo Institute of Medical Sciences, Barabanki, Lucknow, Uttar Pradesh, India, in the month of May 2020. A total of 400 Obstetricians possessing diploma or degree in the speciality performing CS and willing to participate in the study were included. A pretested questionnaire majorly focused on the various surgical techniques of primary CS, performed by the obstetricians, was distributed online. A total 203 respondents completed the questionnaire and their response was recorded. Analysis of Variance (ANOVA), Independent samples t-test and Pearson’s correlation coefficients were used to analyse the data. Results: Majority (n=140, 68.96%) of the respondents were between 25-40 years of age. In the study population, 8 (3.94%) were male respondents and 195 (96.06%) were female respondents. experience of <5 years. The most consistently used technique was the creation of bladder flap (187, 92.11%), while the least common was use of vertical incision (6, 2.9%) for opening the abdomen. There was a huge variation in the method of opening of the abdomen with 117 (57.6%) of obstetricians using blunt versus 86 (42.36%) using sharp dissection. The blunt extension of uterine incision was significantly associated with the increasing years of practice, whereas the preference to use Pfannensteil incision was significantly associated with the younger obstetricians. Conclusion: There was heterogeneity and variation in the CS techniques being practiced by the obstetricians. These varied practices were the result of surgeon preferences, their training and difficulty in unlearning the long used surgical techniques. These are bound to continue until strong evidence-based guidelines for the techniques of CS are formulated.