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Original Article Comparison of Options for Uterine Repair at CS

Pak Armed Forces Med J 2016; 66(4):570-73

EXTERIORIZATION OR IN-SITU REPAIR, COMPARISON OF OPTIONS FOR UTERINE REPAIR AT CESAREAN DELIVERY Bushra Zafar, Farrukh Shehzad, Azra Naseem*, C. Aqeel Safdar** Combined Military Hospital Lahore / National University of Medical Sciences (NUMS) Pakistan, **Liver Pool Hospital Australia, ** Military Hospital/ National University of Medical Sciences (NUMS) Rawalpindi Pakistan

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. Keywords: Caesarean section, Discomfort, Intra-abdominal repair, Operative delivery, Operation time, Uterine exteriorization, Vomiting. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION

well as length of hospital stay4,5. Knowing specific aspects of caesarean section technique helps in determining which method leads to an optimum outcome for women and their babies.

Caesarean section is the oldest known procedure for 400 years1. It is one of the most commonly performed abdominal operations on women in most countries of the world2. Rates have markedly increased in recent years about 20-25% in many developed countries3.

Temporary removal of uterus from the abdominal cavity (exteriorization) has been postulated as a valuable technique for repair of uterine incision (hysterorraphy) after delivery of new born and placental removal either spontaneous or manual4.

Many variations in surgical techniques for cesarean delivery have been proposed, aimed at reducing surgical times, making it easier and more efficient, lowering costs, decreasing the risk of adverse effects and postoperative morbidity, as

Proponents of the technique justify that exteriorization of uterus offers better exposure of the angles and results in an easier and faster repair, thus decreasing intra-operative hemorrhage and also resulting in shorter surgical time less than 45 mins (44% with exteriorized

Correspondence: Dr Bushra Zafar, Consultant Gynecologist, Main operation Theatre, CMH Lahore, Pakistan Email: [email protected] Received: 22 May 2014; revised received: 25 May 2015; accepted: 05 Jun 2015

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Comparison of Options for Uterine Repair at CS

Pak Armed Forces Med J 2016; 66(4):570-73

uterus as compared with 35.3% with in situ uterus)6,7. In addition, they claim that the elevation of the uterus promotes venous drainage, reduces vascular congestion, further contributing to diminished bleeding significant reduction in intraoperative blood loss and less Hb fall (p