Cesarean section is one of the most frequently performed surgical procedures, with increasing rate of recurrent operations worldwide. Different techniques have been practiced in order to reduce morbidity during and after caesarean section, among them the uterine incision repair. The aim of this study is to evaluate the effects of uterine exteriorization versus intraperitoneal repair, in first compared to recurrent caesarean section.
A prospective randomized control single blinded trial conducted in a single tertiary center between January 2014 until march 2015, including 32 and 63 women in first and recurrent cesarean section, respectively. Inclusion criteria were elective operation and gestational age ≥37 weeks. Patients with abnormal placentation, chorioamnionitis, previous other abdominal surgery, past complication during first cesarean section on operation report, bleeding disorder, or urgent operation were excluded. Operative outcomes were compared between the groups including mean operative time, blood loss, hypotension, perioperative nausea and pain. Post operative outcomes were further compared, including post operative analgesia demand, first recognized bowel movement, nausea, length of hospital stay, fever, endometritis surgical site infection rate and total satisfaction. Sub-analysis was done in each group for the different techniques.
21(65.6%) and 48(76.2%) women matched the operation they were allocated in the first and recurrent cesarean section groups, respectively. Intraoperative nausea was found to be the only complication significantly higher in the recurrent cesarean section (n=17 ,40.4%) compared to first cesarean section (n=4 ,16.7%), in the uterine exteriorization group (p=0.046) .This difference was not demonstrated comparing uterine exteriorization to intraperitoneal repair in the recurrent cesarean section group (p=0.856). No other significant differences in either intraoperative or postoperative complications were demonstrated in and between the groups.
Exteriorization of the uterus in recurrent cesarean section is associated with increased incidence of nausea. No other differences in operative and post operative complication rates were found between uterine exteriorization versus intraperitoneal repair comparing first to recurrent caesarean section.
© 2017 Published by Elsevier Inc.