In the Misgav Ladach technique of cesarean section, which specific modification reduces blood loss and operative time compared to the Pfannenstiel-Kerr technique?

• A Use of Joel-Cohen incision (2–3 cm above pubic symphysis) with blunt fascial and peritoneal entry by finger separation
• B Transverse lower segment uterine incision extended digitally without knife, reducing bladder injury
• C Non-closure of visceral and parietal peritoneum to reduce adhesion formation and shorten operative time
• D All of the above are features of the Misgav Ladach technique ✓

Explanation

The Misgav Ladach technique (Israel, 1994) incorporates: (1) Joel-Cohen incision — a straight transverse incision 3 cm above symphysis, higher than Pfannenstiel; (2) blunt fascial separation (instead of cutting with scissors); (3) blunt peritoneal entry by finger instead of incision; (4) digital uterine incision extension; (5) non-closure of both visceral (vesicouterine) and parietal peritoneum; (6) 2-layer mass closure of abdominal wall. Multiple RCTs confirm reduced operative time, blood loss, and pain compared to Pfannenstiel-Kerr technique. The non-closure of peritoneum is particularly associated with fewer adhesions on subsequent surgery.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.