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Jul 10, 2006Article Details
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Which skin incision for caesarean section? Experiences of patients and doctors at three South African public hospitals
Abstract
Background: In South African public hospitals there is still no agreement on the best skin incision for caesarean section (CS). Vertical incisions may be easier to perform, but transverse incisions give better cosmetic results, with reduced risks of wound dehiscence and hernia formation.
Objectives: To explore women's views on CS skin incisions, and to determine incision preferences of obstetric surgeons in three large Johannesburg public hospitals.
Methods: A descriptive study was undertaken in two parts. Interviews were conducted with randomly selected women 3 days after primary CS, and a questionnaire was completed by doctors who regularly performed CS.
Results: Four hundred women were interviewed. There were 247 transverse (62%) and 153 vertical (38%) incisions. Three hundred and seventy-three women said they were satisfied with their skin incisions. Twenty-two stated that they were unhappy with the cosmetic results; of these 21 had had vertical incisions (p < 0.001). Three hundred and ninety-four patients (98.5%) stated that they had received no preoperative counselling on skin incisions. Eighty-five per cent said they would have chosen transverse incisions if given the choice. Fifty-five doctors were interviewed, of whom 96% generally preferred transverse incisions for elective CS, with 49% preferring transverse incisions for emergency CS. Regarding preoperative counselling, 45% of doctors stated that they ‘sometimes' provided information on skin incisions and 21% stated that they ‘always' did so.
Conclusion: While most women in this study were satisfied with their skin incisions, a majority would have chosen transverse incisions if given the choice. Doctors communicate insufficiently with patients about skin incisions at CS. Transverse skin incision should be the approach of choice unless there are specific contraindications.
South African Journal of Obstetrics and Gynaecology Vol. 12(2) 2006: 77-80
Objectives: To explore women's views on CS skin incisions, and to determine incision preferences of obstetric surgeons in three large Johannesburg public hospitals.
Methods: A descriptive study was undertaken in two parts. Interviews were conducted with randomly selected women 3 days after primary CS, and a questionnaire was completed by doctors who regularly performed CS.
Results: Four hundred women were interviewed. There were 247 transverse (62%) and 153 vertical (38%) incisions. Three hundred and seventy-three women said they were satisfied with their skin incisions. Twenty-two stated that they were unhappy with the cosmetic results; of these 21 had had vertical incisions (p < 0.001). Three hundred and ninety-four patients (98.5%) stated that they had received no preoperative counselling on skin incisions. Eighty-five per cent said they would have chosen transverse incisions if given the choice. Fifty-five doctors were interviewed, of whom 96% generally preferred transverse incisions for elective CS, with 49% preferring transverse incisions for emergency CS. Regarding preoperative counselling, 45% of doctors stated that they ‘sometimes' provided information on skin incisions and 21% stated that they ‘always' did so.
Conclusion: While most women in this study were satisfied with their skin incisions, a majority would have chosen transverse incisions if given the choice. Doctors communicate insufficiently with patients about skin incisions at CS. Transverse skin incision should be the approach of choice unless there are specific contraindications.
South African Journal of Obstetrics and Gynaecology Vol. 12(2) 2006: 77-80
