***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in r and omised controlled trials . We aim ed to assess whether any surgical techniques were associated with improved outcomes for women and babies . METHODS CORONIS was a pragmatic international 2 × 2 × 2 × 2 × 2 non-regular fractional , factorial , unmasked , r and omised controlled trial that examined five elements of the caesarean section technique in intervention pairs . CORONIS was undertaken at 19 sites in Argentina , Chile , Ghana , India , Kenya , Pakistan , and Sudan . Each site was assigned to three of the five intervention pairs : blunt versus sharp abdominal entry ; exteriorisation of the uterus for repair versus intra-abdominal repair ; single-layer versus double-layer closure of the uterus ; closure versus non-closure of the peritoneum ( pelvic and parietal ) ; and chromic catgut versus polyglactin-910 for uterine repair . Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision . Women were r and omly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs . All investigators , surgeons , and participants were unmasked to treatment allocation . The primary outcome was the composite of death , maternal infectious morbidity , further operative procedures , or blood transfusion ( > 1 unit ) up to the 6-week follow-up visit . Women were analysed in the groups into which they were allocated . The CORONIS Trial is registered with Current Controlled Trials : IS RCT N31089967 . FINDINGS Between May 20 , 2007 , and Dec 31 , 2010 , 15 935 women were recruited . There were no statistically significant differences within any of the intervention pairs for the primary outcome : blunt versus sharp entry risk ratio 1·03 ( 95 % CI 0·91 - 1·17 ) , exterior versus intra-abdominal repair 0·96 ( 0·84 - 1·08 ) , single-layer versus double-layer closure 0·96 ( 0·85 - 1·08 ) , closure versus non-closure 1·06 ( 0·94 - 1·20 ) , and chromic catgut versus polyglactin-910 0·90 ( 0·78 - 1·04 ) . 144 serious adverse events were reported , of which 26 were possibly related to the intervention . Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section . INTERPRETATION These findings suggest that any of these surgical techniques is acceptable . However , longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects . FUNDING UK Medical Research Council and WHO OBJECTIVE A new technical variant of  caesarean section  was described a few years ago , which is characterised by blunt surgical preparation and simplified seam technique . A prospect i ve investigation compared the differences in the surgery and postoperative process as well as the rate of complications between this Misgav Ladach method and the conventional technique of Sectio . The individual postoperative well-being of the women was recorded by visual analog scales . - PATIENTS AND METHODS Women , whom realize the including criteria s ( first caesarean section , > /= 32 . week of pregnancy , one baby ) , were examined in this study over one year : 105 patients operated with the Misgav Ladach method and 67 conventionally operated patients . The patients were r and omized in a function of the first letter of the surname ( A-K  : Misgav-Ladach method ; L-Z : classical technique )  . - RESULTS The surgical time from the cut to the seam was significantly shorter ( 29.8 vs. 49.3 min ; p < 0,001 ) in the Misgav Ladach group . There were no differences between the two methods in the rate of postoperative complications . The febrile morbidity was equivalent in both groups ( 7.6 % vs. 9 % ) , likewise the frequency of postoperative hematomas ( 3.8 % vs. 3 % ) . The postoperative period with consumption of analgetics was significantly longer in the group of conventionally operated patients ( 1.9 d vs. 2.4 d ; p < 0.01 ) . The postoperative presentness was estimated significantly better ( p < 0,.01 ) by the patients of the Misgav ladach group - probably caused by the significantly earlier mobilization ( p < 0.05 ) . - CONCLUSION The surgical technique described by Misgav and Ladach allows a safe execution of the caesarean section and represents an alternative to the conventional method . The duration of operation ( cut-seam-time ) was significantly shorter . The technique of less traumatising of tissue caused a significantly earlier mobilisation and a significantly shorter requirement of analgetics . The women estimated her postoperative physical condition as better 125 caesarean sections were performed at the Department of Obstetrics and Gynecology , Allgemeines Krankenhaus Celle , during the last 6 months of 1991 . The  caesarean section rate was 13.4 % ( 930 deliveries in that period).--For closure of the uterotomy a two-layer suture was applied ( 62 patients ) as well as a one-layer suture , the modified Sarafoff suture ( 63 patients ) . Both techniques were used alternatively . We compared intraoperative and postoperative courses of the two groups of patients in a prospect i ve study . Between the 8th and 10th day after surgery an ultrasonic examination of the scar was performed . The data in both groups did not show any significant difference , except that the scar in the one-layer group was thinner .-- So , our results did not support an advantage of the one-layer suture as compared to the two-layer technique Aim . To compare Pfannenstiel-Kerr ( PKM ) and Misgav-Ladach ( MLM ) methods in terms of operation-related features and neonatal outcome in primary cesarean deliveries . Methods . A total of 180 pregnant women r and omized into PKM ( n = 90 ) or MLM ( n = 90 ) groups were included in this study . Primary outcome measures were total operative and extraction times , Apgar score , blood loss , wound complications , and the suture use . Secondary outcome measures were wound seroma and infection incidence , time of bowel restitution , and the perceived pain . Results . Total operation and extraction times were significantly shorter and less suture material was used in the MLM group than the PKM group ( p < 0.001 ) . Initially , higher scores obtained for 6 h-VAS in the MLM group ( p < 0.05 ) were normalized after 24 h of the operation . PKM and MLM were similar in terms of preoperative and postoperative levels of hemoglobin and hematocrit , wound complication , bowel restitution , fever , seroma , infection , wound dehiscence and the need for transfusion , antibiotic , and analgesics . Conclusion . The operation-related morbidity of the MLM and PKM for primary C/S seem to be comparable ; however , the MLM seems to be superior in terms of operation time and the amount of suture usage but inferior in pain scores in the early postoperative period OBJECTIVE To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness , blood loss , operative time and scar dehiscence at the time of next caesarean section . STUDY DESIGN A r and omized double blinded trial . PLACE AND DURATION OF STUDY Obstetrics and Gynaecology Department of Bahawal Victoria Hospital , Bahawalpur , from June 2005 to June 2010 . METHODOLOGY Ninety patients undergoing repeat caesarean section were included and r and omly assigned to one of the three groups . Group A underwent one layer closure ; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision . Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence . Frequency percentages were obtained and compared using chi-square test with significance at p < 0.05 . RESULTS In only 2 ( 6.6 % ) of modified two layer closure cases , it was necessary to use additional haemostatic sutures , compared with 16 ( 53 % ) of one layer closure group , and 10 ( 33 % ) of the two layer closure group . At 6 weeks , the mean car thickness in group C ( 17.08 + 1.635 mm ) was significantly greater ( p < 0.001 ) as compared to group A ( 13.19 + 1.32 mm ) and group B ( 14.58 + 1.18 mm ) . At long-term follow-up , only 1 ( 6 % ) case from group C showed the " uterine window " at the time of repeat caesarean section as compared to 3 ( 23 % ) in group A and 2 ( 14 % ) in group B. CONCLUSION Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section Design CORONIS is a pragmatic multicentre fractional factorial r and omised controlled trial and is being conducted in sites in Argentina , Chile , Ghana , India , Kenya , Pakistan and Sudan [ 1 ] . Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision . Five comparisons will be carried out using a 2 balanced incomplete block factorial design . Each woman is allocated THREE of the five pairs of interventions using a bespoke secure webbased r and omisation system ( with 24/7 automated backup telephone system ) hosted by the NPEU Clinical Trials Unit . The 5 pairs of interventions are : i. Blunt versus sharp abdominal entry ii . Exteriorisation of the uterus for repair versus intraabdominal repair iii . Single versus double layer closure of the uterus iv . Closure versus non-closure of the peritoneum ( pelvic and parietal ) v. Chromic catgut versus Polyglactin-910 for uterine repair Primary outcome : death or maternal infectious morbidity ( one or more of the following : antibiotic use for maternal febrile morbidity during postnatal hospital stay , antibiotic use for endometritis , wound infection or peritonitis ) or further operative procedures or blood transfusion . Sample size required : 15,000 women in total ; minimum 9,000 women per comparison pair In recent years Stark and colleagues ( 1 , 2 ) proposed the application to the  cesarean section  of a number of new surgical techniques adopted from various sources : the differences with respect to the traditional procedures were the Joel-Cohen methods for opening the abdomen , suturing the uterus in one layer , and non-closure of the visceral and parietal peritoneal layers . They demonstrated that this cesarean section procedure is safe , fast and has a low risk of postoperative complications in the mothers ( 2 ) and therefore this technique has been adopted in many centers . Nevertheless , the possible consequences of these changes on the short-term outcome of the newborn have never been evaluated . Cesarean section and maternal anesthesia are risk factors for the respiratory distress syndrome , transient tachypnea and respiratory depression in the newborn infants  ( 3 ) and , therefore , we wanted to evaluate if a cesarean section technique presumably faster than the traditional procedure could improve the short-term outcome of the newborns Background Caesarean section is one of the most commonly performed operations on women throughout the world . Rates have increased in recent years – about 20–25 % in many developed countries . Rates in other parts of the world vary widely . A variety of surgical techniques for all elements of the caesarean section operation are in use . Many have not yet been rigorously evaluated in r and omised controlled trials , and it is not known whether any are associated with better outcomes for women and babies . Because huge numbers of women undergo caesarean section , even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women , and significant cost savings . Design CORONIS is a multicentre , fractional , factorial r and omised controlled trial and will be conducted in centres in Argentina , Ghana , India , Kenya , Pakistan and Sudan . Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision .  Five comparisons will be carried out in one trial , using a 2 × 2 × 2 × 2 × 2 fractional factorial design . This design has rarely been used , but is appropriate for the evaluation of several procedures which will be used together in clinical practice . The interventions are : • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum ( pelvic and parietal ) • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity ( one or more of the following : antibiotic use for maternal febrile morbidity during postnatal hospital stay , antibiotic use for endometritis , wound infection or peritonitis ) or further operative procedures ; or blood transfusion . The sample size required is 15,000 women in total ; at least 7,586 women in each comparison . Discussion Improvements in health from optimising caesarean section techniques are likely to be more significant in developing countries , because the rates of postoperative morbidity in these countries tend to be higher . More women could therefore benefit from improvements in techniques . Trial registration The COR 
    Output:
    
There is increasing evidence that for many techniques , short-term maternal outcomes are equivalent .