Background

Caesarean section is the commonest major operation performed on women in the world.

Essentially the operation involves exposing the uterus by entering the abdominal cavity through

the abdominal wall. The lining of the abdomen (peritoneum) is opened and the peritoneum

covering the uterus is usually also entered. The bladder is reflected away from the uterus to

reduce the chance of damage to it during the operation. The uterus is then incised and the baby

and placenta delivered. Adequate haemostasis is achieved by closure of the uterine muscle

followed by closure of the abdominal wall.

There are many possible ways of performing a caesarean section operation, and operative

techniques vary widely. The techniques used may depend on many factors including the clinical

situation and the preferences of the operator. For an overview of surgical techniques, indications

for caesarean section and postoperative complications, see the protocol for a Cochrane review

'Techniques for caesarean section' (Hofmeyr 2004).

This review summarises randomised controlled trials comparing alternative techniques and

materials for closure of the rectus sheath and the superficial (subcutaneous) fat layer of the
abdominal wall. The rectus sheath is the fibrous material which encloses the muscles of the

abdominal wall. The superficial fat lies between the sheath and the skin.