Comparative Evaluation of Blood Loss During Caesarean Section: Electrosurgical Unit Versus Cold Scalpel—A Retrospective Study

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Background/Objectives: Caesarean section (CS) is the most frequently performed abdominal operation worldwide, and surgical technique continues to evolve to reduce peri-operative morbidity. Electrosurgery is now used in the majority of surgical procedures because it allows simultaneous tissue dissection and haemostasis, yet its systematic use during the abdominal-wall phase of CS remains debated, mainly because of concerns about neonatal safety and uncertain benefit in reducing maternal blood loss. This retrospective study aimed to compare the use of an electrosurgical unit with the conventional cold scalpel in women undergoing elective CS. The primary endpoint was maternal blood loss before hysterotomy; the secondary endpoint was the short-term neonatal effect assessed through umbilical cord blood gas analysis. Methods: We retrospectively reviewed 40 elective caesarean sections performed at a tertiary referral centre between September 2024 and May 2025. In 24 procedures (cold scalpel group), the abdominal wall was opened with a cold scalpel, whereas in 16 procedures (ESU group) an electrosurgical unit was used to dissect the subcutaneous abdominal tissues and the muscle fascia and to achieve subcutaneous haemostasis. Blood loss was quantified by weighing laparotomy gauze and by graduated suction. Continuous variables were compared with Student’s t-test for independent samples. Results: The distribution of pre-hysterotomy blood loss departed from normality in both groups (Shapiro–Wilk p < 0.001 and p = 0.003), and the comparison was therefore performed with the Mann–Whitney U test. Pre-hysterotomy blood loss was significantly lower in the ESU group (median 32.5 mL, IQR 25–50) than in the cold scalpel group (median 60 mL, IQR 50–75; Hodges–Lehmann difference −25 mL, 95% CI −45 to 0; p = 0.025; rank-biserial r = 0.42). Differences in haemoglobin, red blood cell and platelet counts measured 24 h after CS did not reach statistical significance (p = 0.27, 0.70 and 0.66, respectively), nor did total blood loss (p = 0.23). Umbilical cord blood gas analysis showed a mean pH of 7.29 ± 0.06 in the ESU group and 7.26 ± 0.08 in the cold scalpel group (p = 0.55), with comparable Apgar scores. Conclusions: In this retrospective series, the use of an electrosurgical unit during the abdominal-wall phase of elective CS was associated with a significant reduction in blood loss up to hysterotomy, with no detectable short-term effect on the neonate. Given the retrospective, non-randomised design and the limited sample size, these findings are hypothesis-generating and require confirmation in adequately powered randomised or prospective studies.

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