Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

Fil: Gialdini C. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina.

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Detalles Bibliográficos
Autores principales: Gialdini, Celina, Chamillard, Monica, Diaz, Virginia, Pasquale, Julia, Thangaratinam, Shakila, Ábalos, Edgardo, Torloni, Maria Regina, Betran, Ana P
Formato: Artículo
Lenguaje:en_US
Publicado: 2025
Materias:
Cesárea
Salud Materna
SALUD PUBLICA
REVISION
Acceso en línea:http://repositorio.cedes.org/handle/123456789/4806
Aporte de:
Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad de Centro de Estudios de Estado y Sociedad (CEDES)
id I61-R167-123456789-4806
record_format dspace
spelling I61-R167-123456789-48062025-07-12T04:18:57Z Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews Gialdini, Celina Chamillard, Monica Diaz, Virginia Pasquale, Julia Thangaratinam, Shakila Ábalos, Edgardo Torloni, Maria Regina Betran, Ana P Cesárea Salud Materna SALUD PUBLICA REVISION Fil: Gialdini C. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina. Fil: Chamillard M. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina. Fil: Diaz V. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina. Fil: Pasquale J. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina. Fil: Thangaratinam S. Institute of Metabolism and Systems Research, University of Birmingham; Birmingham, UK. Fil: Abalos E. Centro de Estudios de Estado y Sociedad (CEDES); Buenos Aires, Argentina. Fil: Torloni MR. Evidence Based Healthcare Post-Graduate Program, Department of Medicine, São Paulo Federal University; São Paulo, Brazil. Fil: Betran AP. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization; Geneva, Switzerland. BACKGROUND: Caesarean section (CS) is the most performed major surgery worldwide. Surgical techniques used for CS vary widely and there is no internationally accepted standardization. We conducted an overview of systematic reviews (SR) of randomized controlled trials (RCT) to summarize the evidence on surgical techniques or procedures related to CS. METHODS: Searches were conducted from database inception to 31 January 2024 in Cochrane Database of Systematic Reviews, PubMed, EMBASE, Lilacs and CINAHL without date or language restrictions. AMSTAR 2 and GRADE were used to assess the methodological quality of the SRs and the certainty of evidence at outcome level, respectively. We classified each procedure-outcome pair into one of eight categories according to effect estimates and certainty of evidence. The overview was registered at PROSPERO (CRD 42023208306). FINDINGS: The analysis included 38 SRs (16 Cochrane and 22 non-Cochrane) published between 2004-2024 involving 628 RCT with a total of 190,349 participants. Most reviews were of low or critically low quality (AMSTAR 2). The SRs presented 345 procedure-outcome comparisons (237 procedure versus procedure, 108 procedure versus no treatment/placebo). There was insufficient or inconclusive evidence for 256 comparisons, clear evidence of benefit for 40, possible benefit for 17, no difference of effect for 13, clear evidence of harm for 14, and possible harm for 5. We found no SRs for 7 pre-defined procedures. Skin cleansing with chlorhexidine, Joel-Cohen-based abdominal incision, uterine incision with blunt dissection and cephalad-caudal expansion, cord traction for placental extraction, manual cervical dilatation in pre-labour CS, changing gloves, chromic catgut suture for uterine closure, non-closure of the peritoneum, closure of subcutaneous tissue, and negative pressure wound therapy are procedures associated with benefits for relevant outcomes. INTERPRETATION: Current evidence suggests that several CS surgical procedures improve outcomes but also reveals a lack of or inconclusive evidence for many commonly used procedures. There is an urgent need for evidence-based guidelines standardizing techniques for CS, and trials to fill existing knowledge gaps. FUNDING: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). 2025-07-11T13:09:52Z 2025-07-11T13:09:52Z 2024-06 Artículo http://repositorio.cedes.org/handle/123456789/4806 10.1016/j.eclinm.2024.102632 en_US EClinicalMedicine;2024 May 19;72:102632
institution Centro de Estudios de Estado y Sociedad (CEDES)
institution_str I-61
repository_str R-167
collection Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad
language en_US
topic Cesárea
Salud Materna
SALUD PUBLICA
REVISION
spellingShingle Cesárea
Salud Materna
SALUD PUBLICA
REVISION
Gialdini, Celina
Chamillard, Monica
Diaz, Virginia
Pasquale, Julia
Thangaratinam, Shakila
Ábalos, Edgardo
Torloni, Maria Regina
Betran, Ana P
Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
topic_facet Cesárea
Salud Materna
SALUD PUBLICA
REVISION
description Fil: Gialdini C. Centro Rosarino de Estudios Perinatales (CREP); Rosario, Argentina.
format Artículo
author Gialdini, Celina
Chamillard, Monica
Diaz, Virginia
Pasquale, Julia
Thangaratinam, Shakila
Ábalos, Edgardo
Torloni, Maria Regina
Betran, Ana P
author_facet Gialdini, Celina
Chamillard, Monica
Diaz, Virginia
Pasquale, Julia
Thangaratinam, Shakila
Ábalos, Edgardo
Torloni, Maria Regina
Betran, Ana P
author_sort Gialdini, Celina
title Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
title_short Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
title_full Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
title_fullStr Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
title_full_unstemmed Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
title_sort evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews
publishDate 2025
url http://repositorio.cedes.org/handle/123456789/4806
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