EXTERIORIZATION OR IN-SITU REPAIR, COMPARISON OF OPTIONS FOR UTERINE REPAIR AT CESAREAN DELIVERY

Comparison of Options for Uterine Repair at CS

Abstract

Objective: Objective of study is to compare peri–operative complications between exteriorization and intraabdominal repair of uterus after cesarean delivery.
Study Design: Randomized controlled trial.
Place and Duration of Study: Obstetrics and Gynecology Department of Pakistan Ordinance Factory Hospital, Wah Cantt, from 1st April 2010 to 30th September 2010.
Material and Methods: Patients planned for 1st cesarean section under spinal anesthesia were randomly allocated by lottery method to exteriorized (A) or in situ uterine repair (B) group. Patients with history of uterine surgeries and cesarean section were excluded from study. Variables analyzed were operation time, peri-operative hemoglobin (Hb) fall, nausea and vomiting during the cesarean delivery.
Results: The study analyzed 170 patients and divided them in 2 groups, having no significant difference with respect to maternal demographics, procedure statistics and indication of cesarean section. Significant difference was observed in operation time being 32.78 min in exteriorized group and 36.38 min in situ uterine repair group (p-value 0.0001). Hb% fall was 0.85 g/dl and 0.92 g/dl respectively in both groups (p-value 0.62) Nausea and vomiting was 23.5% in group A and 11.8% in group B (p-value 0.02, 0.04 respectively)
Conclusion: Peri-operative complications like operative time and Hb fall are less in uterine repair after temporary exteriorization as compared to intra-abdominal repair of uterus after cesarean delivery. Nausea and vomiting were increased in exteriorized group but proper regional anesthetic technique and achieving adequate analgesia can reduce patient discomfort.