Introduction of the Misgav Ladach caesarean section at an African tertiarycentre: a randomised controlled trial

Objective To determine whether the Misgav Ladach caesarean section techniqu e can offer benefits compared with conventional caesarean section technique in the prevailing conditions of a busy African tertiary centre. Design A randomised controlled trial. Setting A tertiary African obstetric unit with 18,000 deliveries annually. Participants Three hundred and thirty-nine women undergoing caesarean secti on. Methods Eight residents and registrars were instructed in the Misgav Ladach technique for caesarean section during one week, after which the study com menced. The course participants instructed their colleagues; in total, 16 d octors participated. Women requiring caesarean section were randomised to M isgav Ladach or to the conventional lower midline incision procedure, exclu ding those with a previous scar. Results During 11 weeks 339 randomised procedures (328 of which were emerge ncy procedures) were carried out. Mean operating time was 25.3 minutes for Misgav Ladach and 32.6 minutes for the lower midline incision procedure (95 % CI -8.3; -6.3). Mean blood loss was 354 mi, and 447 mi, (-133; -53), and the number of sutures 3.1 and 6.1 (-3.1; -2.9), respectively. No significan t difference was found in Apgar scores. Mobilisation was earlier with the M isgav Ladach procedure. No difference was found in overall post-operative i nfection rates i.e. wound infection or febrile illness, but the combination of wound infection and fever was more common in the Misgav Ladach group. Conclusion The Misgav Ladach caesarean section confers benefits such as red uced blood loss, conservation of time and suture material, and rapid mobili sation, but more studies are needed to explore modifications aimed at reduc ing post-operative infections in settings with limited resources.