Scalpel versus Cutting Diathermy Skin Incision in Primary Cesarean Section in Patients Undergoing Anticoagulant Therapy using Low Molecular Weight Heparin: A Randomized Controlled Trial

Background & Objective: Cesarean section is one of the most common surgical procedures worldwide, with ongoing refinements in incision techniques. While the scalpel remains the conventional tool, electrosurgical methods such as cutting diathermy have gained interest due to its potential benefits in reducing incision time and blood loss. However, concerns about wound healing, postoperative pain, and scar formation have limited its acceptance, especially among patients receiving anticoagulant therapy. The present study was conducted with aim to compare scalpel versus cutting diathermy skin incisions in cesarean delivery among women with Low-Molecular-Weight Heparin (LMWH), focusing on incision time, blood loss, postoperative pain, analgesic requirements, and wound complications.Materials & Methods: This randomized controlled trial was conducted at Kasr Al-Ainy Hospital, Cairo University (July 2023-December 2024), including 160 pregnant women on LMWH scheduled for first elective cesarean delivery. Participants were randomized to scalpel (n=80) or diathermy (n=80) skin incision groups. Primary outcomes were incision time and intraoperative blood loss; secondary outcomes included postoperative pain, analgesia use, and wound complications (seroma, hematoma, infection).Results: The diathermy group had significantly shorter incision time (39.7±11.2 s) compared with the scalpel group (89.6±26.1 s; P<0.001) and less blood loss (11.8±3.4 mL vs 17.5±4.8 mL; P<0.001). No significant differences were found between the two groups in postoperative pain, analgesia needs, or wound complications.Conclusion: Cutting diathermy provides faster incision and reduced intraoperative bleeding without increasing postoperative pain or wound complications in LMWH-treated women undergoing cesarean section, supporting its safety and efficiency in this high-risk group.