Caesarean sections are performed as both elective and urgent procedures and the rates are rising. The major complications are intraoperative damage to organs, anaesthetic complications, bleeding, infection and thromboembolism. The techniques used vary considerably. Available evidence from randomised controlled trials suggests that the Joel-Cohen based techniques (Joel-Cohen, Misgav-Ladach) have short-term advantages over Pfannenstiel (11 trials) and traditional lower midline (two trials) methods. Blood loss, operating time, time from skin incision to birth of the baby, use of pain killers, time to oral intake and bowel function or mobilisation and fever are all reduced.
Use of Joel-Cohen based methods could result in improved short-term outcomes and savings for health systems but robust data on long-term outcomes (pain, fertility, morbidly adherent placenta and rupture of the uterus) after the different techniques (including two suture layers compared with single-layer uterine closure) are needed.