Extra-abdominal versus intra-abdominal repair of the uterine incision at caesarean section

Jacobs‐Jokhan, Donna; Hofmeyr, G Justus

doi:10.1002/14651858.cd000085.pub2

Cited by 43 publications

(11 citation statements)

References 17 publications

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“…There is conflicting data on the risks and benefits of exteriorizing the uterus. A Cochrane review examining six studies, which compared extra-abdominal from intra-abdominal uterine repair, found exteriorization to be associated with a significant decrease in postoperative fever [ 51 ]. Two other large studies demonstrated that there were no differences regarding intraoperative complications when comparing hysterotomy closure to either extra-abdominally or intra-abdominally [ 52 , 53 ].…”

Section: Preventionmentioning

confidence: 99%

Bladder Injury During Cesarean Delivery

Tarney¹

2014

CWHR

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Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury.

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Section: Preventionmentioning

confidence: 99%

Bladder Injury During Cesarean Delivery

Tarney¹

2014

CWHR

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“…1 With the objectives of applying evidence-based practices and improving maternal and neonatal outcomes, Enhanced Recovery after Surgery protocols have been adapted for Cesarean delivery, with one of the key components being the optimization of surgical technique. 2,3 An aspect that may be amenable to optimization is the method of uterine repair; uterine exteriorization may improve surgical visualization, hemostasis, and speed of repair; however, its benefits on hemostasis are controversial 4,5 and may not justify the potential added risks of nausea and vomiting, pain, and infection. [6][7][8][9] In 2015, a meta-analysis of 16 studies 10 comparing uterine exteriorization with in situ repair for Cesarean delivery reported that uterine exteriorization was associated with a non-clinically significant reduction in perioperative hemoglobin decrease, but was also associated with a delay in the return of bowel function.…”

mentioning

confidence: 99%

Uterine exteriorization versus in situ repair in Cesarean delivery: a systematic review and meta-analysis

Tan

Taylor

Sharawi

et al. 2021

Can J Anesth/J Can Anesth

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Purpose We conducted an updated systematic review and meta-analysis on maternal outcomes associated with uterine exteriorization compared with in situ repair in women undergoing Cesarean delivery. Methods We searched for randomized controlled trials comparing uterine exteriorization with in situ repair during Cesarean delivery. Primary outcomes were intraoperative nausea and vomiting (IONV) and perioperative decrease in hemoglobin concentration. Secondary outcomes were postoperative nausea and vomiting (PONV), estimated blood loss, fever, endometritis, wound infection, intraoperative and postoperative pain, postoperative analgesic use, duration of surgery and hospital stay, and time to return of bowel function.Results Twenty studies with 20,909 parturients were included. Exteriorization was associated with higher risk of IONV (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.66 to 2.63; I 2 = 0%), with no difference in perioperative hemoglobin concentration decrease (mean difference, -0.06 gÁdL -1 ; 95% CI, -0.20 to 0.08; I 2 = 97%) compared with in situ repair. There were no significant differences in estimated blood loss, transfusion requirement, PONV, duration of surgery, duration of hospital stay, time to return of bowel function, fever, endometritis, or wound infection. Postoperative pain (incidence of pain graded [ 5/10) at six hours (OR, 1.64; 95% CI, 1.31 to 2.03; I 2 = 0%) was higher with exteriorization, but there was no difference in need for rescue analgesia (OR, 2.48; 95% CI, 0.89 to 6.90; I 2 = 94%) or pain scores at 24 hr compared with in situ repair. Conclusions In this updated systematic review and metaanalysis, uterine exteriorization was associated with an increased risk of IONV but no significant change in perioperative hemoglobin decrease compared with in situ repair. Study registration PROSPERO (CRD42020190074); registered 5 July 2020. Re ´sumeÓbjectif Nous avons re´alise´une mise a`jour d'une revue syste´matique et une me´ta-analyse portant sur les issues maternelles associe´es a`l'exte´riorisation de l'ute´rus par rapport a`une re´paration in situ chez les femmes accouchant par ce´sarienne.Me ´thode Nous avons recherche´des e´tudes randomise´es contro ˆle´es comparant l'exte´riorisation de l'ute´rus a`la

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“…9 There was statistically no significant difference between the two groups as far as intra-operative nausea, vomiting is concerned. 5,7 Blood loss is significantly more in the non-eventrated group; uterine eventration at caesarean section is not to be condemned. 10 For active management of the 3 rd stage of labour WHO recommended uterotonics before placental delivery in all cases to prevent PPH.…”

Section: Review Of Literaturementioning

confidence: 96%

“…Exteriorization of uterus is a valid option, as demonstrated by clinical and statistical evidence. 7,8 An alternative surgical sequence of delivering the placenta in the exteriorized uterus with IMM oxytocin showing statistically significant decrease in blood loss seems to be physiologically sound procedure with significant decrease in operative time. 9 There was statistically no significant difference between the two groups as far as intra-operative nausea, vomiting is concerned.…”

Section: Review Of Literaturementioning

confidence: 99%

Exteriorization of uterus before placental expulsion and intra-myometrial oxytocin versus in situ repair and IV oxytocin during LSCS â€“ A comparative study

2020

IJOGR

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Introduction: A suitable modification of any step of caesarean section to reduce blood-loss should be considered as the morbidity and mortality of CS is mostly associated with excessive hemorrhage. Aim: This is a comparative study of uterine exteriorization and intra-myometrial (IMM) oxytocin 5 IU before placental expulsion with conventional method of intra-abdominal repair with 10 IU IV oxytocin with primary objective to compare the blood-loss. Materials and Methods: A prospective study of 2 groups, 100 women in each group (Primis & 2 nd gravidas between 19-34 years of age) having hemoglobin above 10 gm% in cephalic presentation with almost identical indications for CS excluding prematurity, APH, IUGR, bleeding disorders, fibroids etc. Standard caesarean procedure followed except exteriorization of uterus before placenta delivery and IMM oxytocin 5 IU in Gr1; and intra-abdominal repair and slow IV 10 IU oxytocin in Gr2. Preoperative, Postoperative and difference of Hb, duration of surgery from baby birth to starting of abdominal closure, blood-loss by volumetric method noted and compared after mean calculation by student t and chi-square test. Intra-operative and post-operative complications compared by relative risk calculation. Results: The values of postoperative Hb level 99.2 against 89.2g/l, Hb difference between pre-and postoperative level 12.7 against 23.2g/l, blood loss 394.8 ml against 461.6 ml, duration of surgery 11 min 10 sec against 19 min 53 sec were highly significant (p < 0.0001 by student t and chi square test). The hospital stay with relative risk calculation shows significant difference between 2 groups. Conclusion: Exteriorization of uterus before placental separation and IMM oxytocin reduces not only blood loss and time taken in caesarean sections, also the hospital stay.

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Extra-abdominal versus intra-abdominal repair of the uterine incision at caesarean section

Abstract: Ezechi 2005 {published data only} Ezechi OC, Kalu BK, Njokanma FO, Nwokoro CA, Okeke GC. Uterine incision closure at caesarean section: a randomised comparative study of intraperitoneal closure and closure a er temporary exteriorisation.

Cited by 43 publications

References 17 publications

Bladder Injury During Cesarean Delivery

Bladder Injury During Cesarean Delivery

Uterine exteriorization versus in situ repair in Cesarean delivery: a systematic review and meta-analysis

Exteriorization of uterus before placental expulsion and intra-myometrial oxytocin versus in situ repair and IV oxytocin during LSCS â€“ A comparative study

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