A Randomised, Controlled Study of Uterine Exteriorisation and Repair at Caesarean Section

Abstract

Objective To determine the surgical and anaesthetic benefits and problems associated with the practice of routine exteriorisation of the uterus to facilitate repair at caesarean section.Design A randomised controlled study of women undergoing caesarean section. After establishment of anaesthesia, women were randomised to either exteriorisation and uterine repair or suture of the uterus in the abdomen.Setting A maternity hospital in the United Kingdom.Main outcome measures Peri-operative haemoglobin change, duration of operation, maternal morbidity and length of hospital stay. Intra-operative pain, nausea, vomiting, pulling or tugging sensations were secondary outcome measures.Results Three hundred and sixteen women were randomised, of whom 288 were subsequently analysed (139 women in whom the uterus was exteriorised and 149 where the uterus was not exteriorised). Exteriorisation of the uterus, an elective caesarean section and a spinal or general anaesthesia each had a statistically significant association with reduced blood loss (P < 0.05). There were no statistically significant differences between the two groups with regard to intra-operative complications or pain, nor were there any statistically significant difference in post-operative wound sepsis, pyrexia, deep vein thrombosis, blood transfusion or length of hospital stay.Conclusion With effective anaesthesia, exteriorisation of the uterus for repair following caesarean delivery is not associated with significant problems and is associated with less blood loss. Building, Leicester Royal Infirmary LE2 7LX, UK. 0 RCOG 1999 British Journal of Obstetrics and Gynaecology 913 914 M . A . W A H A B ET A L .

Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis

“…Overall pooled results from three studies (439 patients) 7,29,30 did not show a statistically significant difference in the incidence of intraoperative pain between the two repair techniques (OR, 1.52; 95% CI, 0.86 to 2.71; I 2 = 0%) ( Table 3, Fig. 4), but the confidence intervals were wide, suggesting that our data are insufficient to draw definitive conclusions about this outcome.…”

“…7 Three studies included patients who underwent emergent CDs but did not report a standardized anesthetic technique that might impact the occurrence of intraoperative nausea and vomiting. [29][30][31] Therefore, the results of those studies regarding these outcomes must be interpreted with caution. It is noteworthy that studies with nausea and vomiting as primary outcomes favour in situ repair.…”

“…10,12,13,25,29,30 Pooled results showed a statistically significant higher drop in hemoglobin with in situ repair (MD, -0.14 gÁdL -1 ; 95% CI, -0.22 to -0.07) ( Table 3, Fig. 2B).…”

“…Pooled results from ten studies (17,568 patients) 9,[11][12][13][27][28][29][30][31][32] did not show a significant difference between groups for blood transfusion (OR, 1.07; 95% CI, 0.48 to 2.41; I 2 = 51%) ( Table 3, Fig. 2A).…”

“…13,[29][30][31] We contacted one of the Intraoperative nausea and vomiting was a primary outcome in only one study, 7 which reported a statistically significant increased risk of intraoperative nausea in the exteriorization group (OR, 2.95; 95% CI, 1.04 to 8.34). Nevertheless, pooled results of the two repair techniques did not show a statistically significant difference in intraoperative nausea for 2,071 patients (OR, 0.99; 95% CI, 0.74 to 1.34; I 2 = 36%) ( Table 3, Fig.…”