Scalpel vs Diathermy in Repeat Cesarean Delivery

Not Applicable

Completed

Brief Summary: The objective of this study is to compare scalpel vs. diathermy in abdominal wall incision in pregnant patients undergoing repeat elective cesarean delivery.

Detailed Description: It is hypothesized that wall incisions made by diathermy compared to scalpel during repeat cesarean delivery will have less incision time, as well as less blood loss. A second hypothesis is that the use of diathermy, compared with scalpel will not increase in post-operative pain.

1. This is a randomized prospective study in women undergoing elective repeat cesarean delivery at Medical Center Hospital in Odessa Texas.

2. Women undergoing cesarean delivery will be randomized into two groups: One group will undergo diathermy to incise the entire abdominal wall ,which includes skin, subcutaneous tissue, rectus muscle until the peritoneal cavity is visible. On the other group scalpel will be used to achieve the same aim.

3. A standardized abdominal wall incision will be made with either diathermy in cut mode or scalpel. Diathermy will be set in a cut mode with standard setting as per surgeons preference. All patients in the study will get standard skin incision in terms of length and depth which will be marked by a ruler.

4. Incision time ( measured in minutes and seconds with stop watch) and amount of bleeding will be measured. Blood loss will be calculated by weighing (in grams) the "used" lap sponges and comparing this to the weight (in grams0 of "fresh" lap sponges.

5. Post-operative pain will be measured by a Visual Analogue Scale (VAS). Measurements will be taken at 6:00 to 7:00 AM from post -op day 1 until hospital discharge.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Informed consent can't be obtained in a manner that allows for no impression of undue influence/pressure or sufficient time for patient to consider participation.
Primary Cesarean deliveries - as these can bias the selection.
Skin conditions such as infections, psoriasis, and eczema.

Arm && Interventions

Group	Intervention	Description
Diathermy group	Diathermy	In this study group, abdominal wall incisions are made with diathermy which is a electrosurgical instrument.
scalpel group	scalpel	Scalpel is the device used to make abdominal wall incision in this group of patient.

Primary Outcome Measures

Name	Time	Method
Incision Time .	during surgery	Time to make an abdominal wall incision from skin to rectus fascia.

Secondary Outcome Measures

Name	Time	Method
Post Operative Pain	Post Operative Day (POD) 1 and Day 2	Done by VAS scale. Visual Analog Scale to measure pain. Scale range from 0 to 10 with higher values indicating worse pain.
Blood Loss	Blood lost during incision/surgery	Blood lost during incision/surgery