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Jul 12, 2024 · There are now thousands of randomized trials on the different steps for the technique for cesarean birth. The following discussion will review each step in the procedure and provide evidence-based recommendations for surgical technique, when these data are available.
Jun 24, 2020 · Joel cohen is a type of abdominal incision used for cesarean section. It is a slight modification of the classic Pfannensteil incision which is most commonly...
Nov 5, 2018 · Different types of skin incisions of the abdominal wall can be used for caesarean section. Patterns include vertical (midline and paramedian) incisions and transverse incisions (Pfannenstiel-Kerr, Joel-Cohen, Misgav Ladach, and Modified Misgav Ladach).
- Jan-Simon Lanowski, Constantin S. von Kaisenberg
- 2018
Oct 29, 2008 · The Joel-Cohen technique includes straight transverse incision through skin only, 3 cm below the level of the anterior superior ileac spines (higher than the Pfannenstiel incision). The subcutaneous tissues are opened only in the middle 3 cm.
- Lateral Tilt
- Skin Cleaning
- Adhesive Drapes
- Skin Incision
- Subcutaneous Incision/Opening
- Fascial Incision
- Rectus Muscle
- Opening of The Peritoneum
- Bladder Flap
- Uterine Incision
Lateral tilt is a consolidated obstetric practice to reduce the aortocaval compression by the gravid uterus. This reduction is reached with a lateral tilt of 12.5°–15° . This intraoperative position can also cause compression of the underlying structures defined as a sciatic neuropathy, and for this reason, it is important to reduce the time in thi...
The purpose of the skin cleaning is to reduce the bacterial colonization. Usually the skin preparation is performed with a preoperative shower, then a scrub with bactericidal soap in the operating room, followed by application of a long-acting bactericidal agent. A systematic review has shown that no reduction in surgical site infection was found f...
Adhesive drapes do not reduce surgical site infection. This was evaluated in a systemic review of randomized trials which demonstrated no benefit. Also, the iodine-impregnated adhesive drape versus no adhesive drape had no effect on the surgical site infection rate (RR, 1.03; 95% CI 0.064–1.66) [25, 48].
In general, a transverse incision is most commonly used for cesarean delivery since it is associated with less postoperative pain, greater wound strength, and better cosmetic results than the midline incision . Midline incisions compared with transverse incisions have more wound dehiscence/infection (eight times more; 2.94% VS 0-0.37%) and undoubt...
The safety and efficacy of electrocautery compared with the cold scalpel for midline abdominal incision was analyzed in a multicenter collaborative study. On animal trials, the use of electrocautery had shown an increment of wound infection. These findings were not confirmed in this clinical trial that involved 964 patient, and the results reported...
There are no randomized trials comparing different techniques of opening the fascia at CS. Most experts recommend a transverse incision that is performed with the scalpel and then extended with scissors. Alternatively, the fascial incision can be extended laterally with the fingers (Misgav-Ladach techniques) .
The rectus muscle can be separated bluntly or by scissors. Various studies have shown that cutting transversely the rectus muscle versus not cutting was not associated with any difference in operative morbidity, difficult deliveries, increase of postoperative complications, or higher pain scores. For this reason, transecting the rectus muscle seems...
Opening of the peritoneum has not been studied separately in a randomized trial. Many authors recommend opening the peritoneum carefully using the fingers to minimize the risk of injury to other organs adherent to the underlying surface. For this reason, a sharp entry is considered unnecessary [47, 52].
Bladder flap was studied in a single trial involving 102 women delivering by cesarean section. The omission of the bladder flap (direct incision 1 cm above the bladder fold) was associated with a reduction in operating time (5 vs. 7 min; P = 0.001), blood loss [postoperative microhematuria (21% vs. 47%; P = 0.01) and need for analgetics (26% vs. 55...
Uterine incision can be performed in many different ways. The way of incision depends on many factors including the position of the fetus, the location of the placenta, and development of the lower uterine segment. The most common procedure is the transverse incision of lower uterine segment (called Kerr incision or Monroe-Kerr) also because, compa...
- Daniele Bolla, Andrea Schöning, Gero Drack, René Hornung
- 2010
Joel-Cohen incision is a skin incision used for Caesarean section. It is a straight incision that is 3 cm below the line joining both anterior superior iliac spines. It is similar to the Pfannenstiel incision, another commonly used incision in obstetric surgery.
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What is the Joel-Cohen technique?
Nov 23, 2012 · Joel-Cohen incision is straight, 3 cm below the line that joins the anterior superior iliac spines, slightly more cephalad than Pfannenstiel.
