Uterine exteriorization compared with in situ uterine repair at cesarean delivery

Abstract

The aim of this study was to compare intra-operative and postoperative effects of exteriorized and in situ repair of the uterine incision at Cesarean Section (CS). One hundred and sixty patients were randomly allocated to one of the two treatment groups in situ or exteriorized uterine repair (n= 80 for each group). Patients were assessed for parameters including , estimated blood loss as primary outcome and secondry outcomes including nausea and vomiting, duration of uterine repair, postoperative pain, duration of hospital stay and infection of surgical site at 7th and 15th days after CS. Both groups were matched as regarding age, weight and height. The mean age was 23.6 among patients of the in situ uterine repair versus 24.1 among patietns of exteriorized uterine repair (p-value > 0.05). Mean weight and height were incomparable in both groups with no statistical significance. No statistically significant difference was found between both groups regarding mean Gestational Age (GA) with mean GA of 38.1 in group 1 (in situ group) versus 38.2 in group 2 (exteriorized group). Difference between both treatment procedures as regards the Intraoperative post-delivery complications was variable. Nausea was significantly more incident among exteriorized group (42% versus 20%; p-value < 0.05) and tachycardia was significantly more among exteriorized group (p < 0.05), vomiting was significantly different among both groups (p < 0.05) while hypotension, hemoglobin level was insignificantly different (p > 0.05). Duration of uterine repair and duration of surgery was significantly shorter with exteriorized uterine repair (p-value < 0.05). However, statistically insignificant, incidence of nausea, vomiting, infection of surgical site at 7th and 15th days postoperatively were numerically more among patients treated with exteriorized uterine repair. Duration of hospital stay was significantly longer among patients of exteriorized group (p-value < 0.05). In conclusion, however, exteriorization of uterus resulted in significantly less duration of uterine repair and duration of surgery, exteriorization did not result in significant reduction of incidence of intra and post-operative complications and it increased the duration of hospital stay. So, it is not recommended for use whenever not indicated.