Complications of Exteriorized Compared With In Situ Uterine Repair at Cesarean Delivery Under Spinal Anesthesia

Abstract

I.

Comparison of uterine exteriorization and in situ repair during cesarean sections

“…Also, it has been reported that the elevation of the uterus promotes venous drainage and reduces vascular congestion, further contributing to decreased blood loss [12]. However, most studies do not support the argument that no significant difference exists between these two techniques regarding blood loss and hematocrit levels [2,11,12]. In our study, we also found no significant differences between two groups when comparing blood loss and hematocrit levels.…”

“…The decreased blood loss might also be related to better visualization of the uterus and more rapid uterine repair after uterine exteriorization from the abdomen [15]. Also, it has been reported that the elevation of the uterus promotes venous drainage and reduces vascular congestion, further contributing to decreased blood loss [12]. However, most studies do not support the argument that no significant difference exists between these two techniques regarding blood loss and hematocrit levels [2,11,12].…”

“…It has been reported that intraoperative nausea and vomiting were significantly higher when uterine repair was performed exteriorly compared with in situ repair in a recent study [12]. Nausea and vomiting during cesarean sections were most frequently related to fundal traction during exteriorization [7,15].…”

“…To our knowledge, there are only two other studies that have evaluated tachycardia and hypotension in relation to these two surgical techniques [12,17]. Siddiqui et al [12] found that the exteriorized group exhibited a significantly higher incidence of tachycardia and a non-significant increase in the incidence of hypotension and pain. These events tended to coincide with the repositioning of the uterus in the abdominal cavity.…”

“…It has been suggested by earlier studies as a useful technique for decreasing perioperative bleeding [7][8][9][10]. However, recent studies do not support these findings [11,12]. In situ uterine repair was found to be more advantageous than exteriorization in relation to the infectious morbidity and postoperative pain in some studies [11,13].…”