Publication:

A randomized comparative study of exteriorization of uterus versus in situ intra-peritoneal repair at cesarean delivery

Background Various caesarean delivery techniques have been compared in the past to assess the associated short-term and long-term advantages and disadvantages. Although uterine exteriorization at caesarean section is popular among obstetricians, safety of this technique remains a disputed matter. The aim of the present study was to compare the influence of uterine exteriorization or in situ repair on caesarean section morbidity.

Methods In this prospective, randomized, controlled study, 200 pregnant women with indication for caesarean delivery were randomized as 100 patients each in the exteriorization group and in the in-situ group. Data on mean time taken for uterine incision closure, intra-operative blood loss and post-operative morbidities were collected and compared between the two groups for statistical analysis.

Results A statistically significant trend towards lesser mean time taken for the uterine wound repair was observed in the exteriorization group. However significantly more number of patients had increased post-operative pain and need for additional analgesia in exteriorization group. There was no significant difference with respect to intra-operative blood loss and incidence of nausea and vomiting; incidence of post-operative endomyometritis, febrile morbidity, wound infection, time taken for return of bowel function and length of hospital stay among the two groups.

Conclusions We concluded that uterine exteriorization and in situ repair have similar post-operative caesarean section morbidity outcomes. However, in situ repair of uterus was associated with lesser post-operative pain, and exteriorization of uterus was associated with lesser operating time.