{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:12:36Z","timestamp":1775841156850,"version":"3.50.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001829","name":"Universiteit Utrecht","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Cesarean sections (CS) are among the most performed surgical procedures in the world. Small variations in surgical techniques could have a significant impact on a global scale, for example, in postoperative complications. In the present study we aimed to observe and audit every single step used during first time CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Descriptive cross\u2010sectional study from January 1, 2018 to January 14, 2020 at a tertiary hospital in Ghana. Techniques used for CS were directly observed and thoroughly documented. Standard descriptive methods were used for data analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1013 first time CS, 81.4% were emergency procedures. The mean (SD) gestational age at CS was 38.4\u2009\u00b1\u20093\u2009weeks. Low transverse incision was used in 993\/1013 (98%) of cases. Blunt dissection of subcuticular tissue was done in 48\/1013 (4.7%), blunt separation of rectus fascia in 386\/1013 (38.1%), blunt opening of peritoneum in 838\/1013 (82.7%) and lower uterine segment incision with scalpel in 995\/1013 (98.2%) women. A total of 916\/1013 (90.4%) had double layered uterine closure, 961\/1013 (94.9%) had uterus exteriorized for repair, 382\/1013 (37.7%) had closure of the peritoneum, 655\/1013 (64.7%) had non\u2010closure of the rectus muscle, 677\/1013 (66.8%) had subcutaneous tissue closed and 983\/1013 (97.0%) had skin closed with subcuticular stitches. There were 493 different combinations of techniques observed performed by 85 surgeons for carrying out a complete first time CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a wide variety of methods used for first time CS. There is the need for training and retraining on the techniques for CS using evidence\u2010based guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.16133","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T08:13:25Z","timestamp":1735546405000},"page":"707-719","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cesarean section: One procedure, varied techniques. Detailed observations of 1013 first cesarean sections in a tertiary hospital in Ghana"],"prefix":"10.1002","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4770-8837","authenticated-orcid":false,"given":"Kwaku","family":"Asah\u2010Opoku","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Ghana Medical School  Accra Ghana"},{"name":"Department of Obstetrics and Gynecology Korle\u2010Bu Teaching Hospital  Accra Ghana"},{"name":"Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby University Medical Center  Utrecht The Netherlands"},{"name":"Utrecht University  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Heesterman","sequence":"additional","affiliation":[{"name":"Utrecht University  Utrecht The Netherlands"},{"name":"Julius Global Health, Julius Center for Health Sciences and Primary Care University Medical Center  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona Lu","family":"Zeevaert","sequence":"additional","affiliation":[{"name":"Utrecht University  Utrecht The Netherlands"},{"name":"Julius Global Health, Julius Center for Health Sciences and Primary Care University Medical Center  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kofi","family":"Agyabeng","sequence":"additional","affiliation":[{"name":"Department of Statistics, School of Public Health University of Ghana  Accra Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce L.","family":"Browne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby University Medical Center  Utrecht The Netherlands"},{"name":"Utrecht University  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson","family":"Damale","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Ghana Medical School  Accra Ghana"},{"name":"Department of Obstetrics and Gynecology Korle\u2010Bu Teaching Hospital  Accra Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rick","family":"Grobbee","sequence":"additional","affiliation":[{"name":"Utrecht University  Utrecht The Netherlands"},{"name":"Julius Global Health, Julius Center for Health Sciences and Primary Care University Medical Center  Utrecht The Netherlands"},{"name":"Department of Statistics, School of Public Health University of Ghana  Accra Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercy A.","family":"Nuamah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Ghana Medical School  Accra Ghana"},{"name":"Department of Community Health Family Health Medical School  Teshie Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kitty W. M.","family":"Bloemenkamp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby University Medical Center  Utrecht The Netherlands"},{"name":"Utrecht University  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus J.","family":"Rijken","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby University Medical Center  Utrecht The Netherlands"},{"name":"Utrecht University  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13618"},{"key":"e_1_2_12_3_1","first-page":"701","volume-title":"Interpretation of caesarean section classifications","author":"Rijken MJ","year":"2019"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.026"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31930-5"},{"key":"e_1_2_12_6_1","first-page":"1","article-title":"Time to consider the risks of caesarean delivery for long term child health","volume":"350","author":"Blustein J","year":"2015","journal-title":"BMJ (Online)"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32386-9"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30036-1"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-017-0388-0"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2009.03.023"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.15553"},{"key":"e_1_2_12_14_1","unstructured":"Ghana Health Service. Ghana Health Service.2016 Annual Report.2017http:\/\/www.ghanahealthservice.org\/ghs\u2010item\u2010details.php?cid=5&scid=52&iid=127"},{"key":"e_1_2_12_15_1","article-title":"2016 Annual Report","author":"Korle\u2010Bu Teaching Hospital","year":"2016","journal-title":"Annu Rep"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60441-9"},{"key":"e_1_2_12_17_1","unstructured":"NICE.Caesarean birth NICE guideline.2021www.nice.org.uk\/guidance\/ng192"},{"issue":"3","key":"e_1_2_12_18_1","first-page":"36","article-title":"Comparison between modified Misgav\u2010Ladach and Pfannenstiel\u2010Kerr techniques for cesarean section: review of literature corresponding author","volume":"8","author":"Vitale SG","year":"2014","journal-title":"J Prenat Med"},{"key":"e_1_2_12_19_1","first-page":"181","volume-title":"Obstetric Interventions","author":"Scherjoin S","year":"2017"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00204-X"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102632"},{"issue":"2","key":"e_1_2_12_22_1","article-title":"Audit of caesarean section documentation","volume":"20","author":"Saeed J","year":"2016","journal-title":"J Rawalpindi Med Coll"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-139"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_2_12_25_1","volume-title":"Obesity: Preventing and Managing the Global Epidemic(WHO Technical Report Series, No.894)","author":"World Health Organization","year":"2000"},{"key":"e_1_2_12_26_1","unstructured":"(SOGOG).National Caesarean section guidelines.2022file:\/\/\/C:\/Users\/User\/Downloads\/SOGOG\u2010CS\u2010Guideline.pdf"},{"key":"e_1_2_12_27_1","unstructured":"NICE.Surgical site infections: prevention and treatment. NICE guideline.2019www.nice.org.uk\/guidance\/ng125"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114190"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31824c0e12"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1461829"},{"issue":"8","key":"e_1_2_12_31_1","article-title":"Closure versus non\u2010closure of the peritoneum at caesarean section: short\u2010 and long\u2010term outcomes","volume":"2014","author":"Bamigboye A","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000462"},{"issue":"8","key":"e_1_2_12_33_1","article-title":"Preoperative hair removal to reduce surgical site infection (review)","volume":"8","author":"Tanner J","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2015.06.020"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/1750458918767592"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.infpip.2022.100203"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-018-0473-0"},{"issue":"1","key":"e_1_2_12_38_1","first-page":"62","article-title":"Maternal hypotension during spinal anesthesia for caesarean delivery","volume":"79","author":"Mercier FJ","year":"2013","journal-title":"Minerva Anestesiol"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003643-201006121-00534"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpaic.2016.04.003"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2019.08.009"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007462.pub4"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2016.09.017"},{"issue":"6","key":"e_1_2_12_44_1","article-title":"Skin preparation for preventing infection following caesarean section","volume":"6","author":"Hadiati DR","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1315347"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.04.035"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.13797"},{"issue":"3","key":"e_1_2_12_48_1","article-title":"Methods of delivering the placenta at caesarean section","author":"Anorlu RI","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1369522"},{"key":"e_1_2_12_50_1","unstructured":"Accra KB.Society of Gynaecologists & Obstetricians of Ghana (SOGOG).2022https:\/\/www.sogog.com\/"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.16133","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T15:08:49Z","timestamp":1745248129000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.16133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,30]]},"references-count":49,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ijgo.16133"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.16133","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,30]]},"assertion":[{"value":"2024-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}