Uterine exteriorization versus intraperitoneal repair in primary and repeat cesarean delivery: a randomized controlled trial

Abstract

Purpose

The aim of this study is to evaluate the effect of uterine exteriorization versus intraperitoneal repair, in first compared to repeat cesarean delivery.

Methods

A prospective randomized control single-blinded trial conducted in a single tertiary center between March 2014 and March 2015, including 32 and 63 women in first and recurrent cesarean sections, respectively. Inclusion criteria were elective operation and gestational age ≥37 weeks. 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.

Results

During the study period, 45 and 50 women were designated for uterine exteriorization and intraperitoneal uterine repair, respectively. Mean blood loss was 452 cc (±10.44) for the extraperitoneal compared to 540 cc (±29.83) for the intraperitoneal uterine repair group (p = .004). No other significant differences in either intraoperative or postoperative complications were demonstrated in and between the groups.

Conclusion

Intraperitoneal repair of uterine incision is associated with higher operative blood loss compared to uterine exteriorization. No other differences in operative and postoperative complication rates were found between the groups.

Keywords:

• Intraperitoneal repair
• primary cesarean delivery
• repeat cesarean delivery
• uterine exteriorization
• uterine insicition

Author’s contribution

Aya Mohr-Sasson – conception, carrying out, planning, analyzing and writing up

Elias Castel – conception, carrying out

Irina Luria – conception, carrying out

Sigal Heifetz – carrying out

Sailm Kees – carrying out

Eyal Sivan – planning, analyzing and writing up

Disclosure statement

No potential conflict of interest was reported by the author(s).