Influence of uterine exteriorization versus in situ repair on post-cesarean maternal pain: a randomized trial

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

“…A seventh study reported preoperative and 48-hr postoperative hemoglobin but did not report the standard deviation for the drop in hemoglobin for the two groups; therefore, the study could not be included in the analysis. 8 This study reported that the drop in hemoglobin did not differ significantly between the groups.…”

“…Although the effect of exteriorization on the control of hemostasis is controversial, 3,4 opponents to exteriorization are concerned about the side effects of uterine traction, including nausea and vomiting, pain, hemodynamic instability, trauma to the fallopian tubes, infection, and rupture or reduced flow of the utero-ovarian veins with consequent thrombosis or embolism. [5][6][7][8] A recent meta-analysis 4 published in 2009 compared the two methods of uterine repair in over 3,000 women, and results showed no difference in outcomes between the two repair techniques. Since the 2009 publication, three large randomized controlled trials and two smaller trials have been published, [9][10][11][12][13] increasing the number of women studied to over 16,000.…”

“…Many studies reported postoperative pain outcomes (including pain at six hours, 13,31 ten hours, 8 24 hr, 29,31 34 hr, 8 or 36 hr 31 postoperatively), the number of analgesic doses, 9,31,32 the need for postoperative rescue analgesics, 8,[11][12][13]31 and opioid consumption. 10 A detailed summary of these results for postoperative pain outcome is presented in Table 4.…”

A randomized comparative study of exteriorization of uterus versus in situ intra-peritoneal repair at cesarean delivery

“…The main disadvantage is intraoperative discomfort to the patient, nausea and vomiting caused by traction during exteriorization, hemodynamic instability, damage to the fallopian tubes, infection, and rupture or reduced flow of the uteroovarian veins which may lead to thrombosis or embolism. [4][5][6][7][8] The effect of exteriorization of uterus over haemostasis during cesarean is still a matter of controversy. [9][10] We performed this randomized study to compare intraoperative and perioperative outcomes with uterine exteriorization versus in situ repair of uterine incision at cesarean delivery.…”

Technical aspects of the cesarean section

“…The metaanalysis suggests that there is no significant difference in outcome leaving the uterus intra-abdominally or exteriorization for uterine incision repair (except for the shorter operating time and less nausea) [13,39].…”