Uterine exteriorization versus In situ repair of the uterine incision at cesarean delivery

Abstract

Background: Opinion appears divided on uterine exteriorization for uterine repair at Cesarean delivery. The available evidence appears insufficient to aid policy pronouncement of routine uterine exteriorization for repair of the lower segment incision. Aim: To evaluate the effect of extra-abdominal versus intra-abdominal repair of the uterine incision at Cesarean delivery. Materials and Methods: One hundred and seventy women were randomly assigned to groups; Group “A” had their repairs after exteriorization while Group “B” had in situ repair. It compared the effects of exteriorization of the uterus and in situ repair during Cesarean delivery. Outcome measures included: Intraoperative blood loss, postpartum anemia, transfusion rate, mean operative time, postoperative wound infection rate, nausea and vomiting, The data were analyzed using Statistical Package for the Social Sciences, version 20. Results: A data were available for analysis in 169 women that completed the study (exteriorization group [n = 85] and in situ repair group [n = 84]).Except for the statistically higher incidence of nausea/vomiting among the women that had exteriorization when compared with their counterpart whose uteri were repaired in situ(10.6% vs. 2.4%; P = 0.031). There were no statistically significant differences between the two groups in terms of the mean preoperative hematocrit (34.8% vs. 35.7%), P = 0.830; the mean postoperative hematocrit level (30.8 ± 4.7 vs. 30.8 ± 4.9), P = 0.958; the mean estimated blood loss (575 ml vs. 577 ml), P = 0.942; the postpartum anemia (35.3% vs. 26.2%), P = 0.200; transfusion rate was (15.3% vs. 17.9%), P = 0.518; operation time (57.5 vs. 53.2 min), and the surgical site infection rate (1.2% vs. 1.2%), P = 0.993. Conclusion: Exteriorization and in situ repair of uterine incisions had similar outcome but, the former is associated with significant higher incidence of nausea/vomiting.