The Joel-Cohen incision is used as an alternative to the Pfannenstiel incision for caesarean section. The CAESAR trial and Cochrane reviews compare these techniques. Which of the following describes the anatomical difference between the Joel-Cohen and Pfannenstiel techniques?
- A Joel-Cohen is a midline vertical incision; Pfannenstiel is a transverse lower abdominal incision
- B Joel-Cohen requires closure of the peritoneum; Pfannenstiel avoids peritoneal closure
- C Joel-Cohen requires cutting through the rectus abdominis muscles; Pfannenstiel separates them in the midline
- D Joel-Cohen uses a straight transverse incision 3 cm above the pubic symphysis with blunt extension; Pfannenstiel uses a curved incision 2–3 cm above the symphysis with sharp dissection ✓
Explanation
The Joel-Cohen incision is a straight (not curved) transverse skin incision made slightly higher (approximately 3 cm above the symphysis pubis) than the Pfannenstiel incision. It uses predominantly blunt tissue dissection (digital tearing of the subcutaneous tissue and rectus sheath) rather than sharp cutting, and avoids dissection of the bladder flap in many modifications. The Pfannenstiel uses a curved 'smile' incision 2–3 cm above the symphysis, followed by sharp dissection of the subcutaneous tissue and rectus sheath. Joel-Cohen technique is associated with shorter operating time and less blood loss. Both use transverse skin incisions.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.