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

Abstract

Background: Various caesarean delivery techniques have been compared in the past to assess the associated short-term and long-term advantages and disadvantages. Although uterine exteriorization at caesarean section is popular among obstetricians, safety of this technique remains a disputed matter. The aim of the present study was to compare the influence of uterine exteriorization or in situ repair on caesarean section morbidity.Methods: In this prospective, randomized, controlled study, 200 pregnant women with indication for caesarean delivery were randomized as 100 patients each in the exteriorization group and in the in-situ group. Data on mean time taken for uterine incision closure, intra-operative blood loss and post-operative morbidities were collected and compared between the two groups for statistical analysis.Results: A statistically significant trend towards lesser mean time taken for the uterine wound repair was observed in the exteriorization group. However significantly more number of patients had increased post-operative pain and need for additional analgesia in exteriorization group. There was no significant difference with respect to intra-operative blood loss and incidence of nausea and vomiting; incidence of post-operative endomyometritis, febrile morbidity, wound infection, time taken for return of bowel function and length of hospital stay among the two groups.Conclusions: We concluded that uterine exteriorization and in situ repair have similar post-operative caesarean section morbidity outcomes. However, in situ repair of uterus was associated with lesser post-operative pain, and exteriorization of uterus was associated with lesser operating time.

The Health Impact of Surgical Techniques and Assistive Methods Used in Cesarean Deliveries: A Systemic Review

“…However, the difference did not reach a statistical significance ( p > 0.05). A similar result was found in many previous studies and in a recent meta-analysis, which concluded that there was no significant difference between these two uterine repair techniques for the length of hospital stay [ 17 , 21 , 37 , 44 , 47 ]. In terms of the length of hospital stay, it seems that there is neither a marked difference nor a strong association by using different uterine repair techniques.…”

“…They concluded that shorter operating times also benefited from less blood loss and better accessibility while repairing the exteriorized uterus [34]. Moreover, in another study, a shorter time for uterine closure was found in the exteriorized uterine repair group than in the in situ group [47]. However, Doganay et al reported significantly shorter mean operative time in the in situ uterine repair group (36.8 vs. 44.6 min) than in the exteriorized uterine repair group in a large-scale randomized controlled trial, including 5002 women [36].…”

“…Postoperative pain could substantially relate to the patient’s satisfaction and subjective feelings about the surgery. Previous research has shown that patients who underwent exteriorized uterine repair during cesarean delivery had a greater chance to experience more severe pain and to take additional analgesia [ 17 , 46 , 47 , 49 ]. It is hypothesized that increased stretching of the uterine ligament and parietal peritoneum while exteriorizing the uterus contributed to this result [ 47 ].…”

“…Many studies investigated the rate of postoperative fever in different uterine repair groups, and most of the results revealed no significant differences among them [ 21 , 34 , 38 , 47 , 49 , 51 ]. Likewise, the incidences of endometritis and wound infection following cesarean delivery were similar in the two groups of exteriorized and in situ uterine repair techniques [ 17 , 34 , 35 , 36 , 37 , 44 , 47 ]. Batsu et al [ 35 ] reported that manual removal of the placenta during cesarean surgeries is a major risk factor for endometritis.…”