Abstract
Repeat cesarean sections (CS) are associated with additional risks of perioperative complications. The aim of our study was ultrasound evaluation of uterine involution in women after repeat traditional cesarean delivery and after repeat CS using argon plasma coagulation and prophylactic use of tranexamic acid and carbetocin. Materials and methods. Prospective cohort study has been conducted on 140 patients who underwent second CS. Group I included 70 women who had repeat CS with the use of argon plasma coagulation and administration of 100 mcg carbetocin after cutting the umbilical cord. Ten minutes before the operation, 15 mg/kg of tranexamic acid was injected intravenously. Group II consisted of 70 women who had traditional CS, 10 IU dose of oxytocin, divided between 5 UI intravenous bolus dose and slow intravenous infusion, was administered after delivery of the baby. A serial ultrasonographic examination was carried out on the 2nd and 5th day of the postpartum period. Results. A study of the dynamics of changes in uterine body and uterine cavity volume revealed a faster rate of uterine cavity involution in group I compared with group II (p<0.05). In group I on the 5th day in comparison to the 2nd day the mean uterine body volume decreased by 27.75%, in group II – by 20.17%. In group I mean uterine cavity volume declined in three days by 21.09%, in group II – 14.22%. Uterine subinvolution was diagnosed in 3 (4,29%) cases in group I and in 19 (27,14%) cases in group II (p<0.05). Faster uterine involution in group I is probably associated with techniques, that were applied during intraoperative period. In addition, 2.86% (2 cases) from the group I versus 31.43% (22 cases) from the group II, needed additional uterotonic therapy after surgery (methylergometrine, misoprostol) (p<0.001). Conclusion. We have found differences in the course of uterine involution in women in group I in comparison with group II, such as significantly smaller uterine length on the 2nd and 5th day, significantly smaller uterine body and uterine cavity volume, faster rates of involution of the uterine cavity during the first 5 days of the postpartum period, thinner anterior uterine wall in the sutured area. We therefore conclude that complex use of tranexamic acid, carbetocin and argon plasma coagulation appears to be effective to maintain adequate uterine involution after repeat CS and prevent postoperative complications.
Highlights
The rate of cesarean delivery in Ukraine, the same as in other countries, does not tend to decrease and it ranges from 11 % to 29 %, reaching even more than 50 % in perinatal centers
Group II consisted of 70 women who had traditional cesarean sections (CS), slow intravenous infusion of 10 IU of oxytocin, divided between 5 UI intravenous bolus dose and slow intravenous infusion, was administered after delivery of the baby
In group I on the 5th day in comparison to the 2nd day the mean uterine body volume decreased by 27.75 %, in group II – by 20.17 %
Summary
The rate of cesarean delivery in Ukraine, the same as in other countries, does not tend to decrease and it ranges from 11 % to 29 %, reaching even more than 50 % in perinatal centers. The most frequent complications of postoperative period are uterine subinvolution, endometritis, wound suppuration and hematomas [1, 2]. Fever and endometritis is relatively frequent after CS (1.7–11 %), compared with vaginal delivery (1–2 %) [3]. The rate of uterine involution is one of the important prognostic criteria for the course of the postpartum period. Subinvolution is one of the earliest clinical manifestations of the pathological course of the postpartum period. According to a literature review, the rate of subinvoluted uterus varies from 11 % to 51.5 % of all postpartum pathology [4]
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