Uterine exteriorization compared with in situ uterine repair at cesarean delivery

Cesarean delivery is defined as the birth of a fetus through incisions in the abdominal wall (laparotomy) and the uterine wall (hysterotomy). This definition does not include removal of the fetus from the abdominal cavity in the case of rupture of the uterus or in the case of an abdominal pregnancy.Objectives: The aim of this study was to compare intra-operative and post-operative effects of exteriorized and in situ repair of the uterine incision at Cesarean Section (CS).Patients and methods: One hundred patients were randomly allocated to one of the two treatment groups in situ or exteriorized uterine repair (n = 50 for each group). Patients were assessed for intraoperative parameters including intraoperative nausea and vomiting, estimated blood loss and duration of uterine repair. Postoperatively, patients were assessed nausea and vomiting, postoperative pain, duration of hospital stay and infection of surgical site at 7th and 15th days after CS.Results: Both groups were matched as regarding age, weight and height. The mean age was 23.2 among patients of the in situ uterine repair versus 22.8 among patietns of exteriorized uterine repair (p-value > 0.05). Mean weight and height were incomparable in both groups with no statistical significance. No statistically significant difference was found between both groups regarding mean Gestational Age (GA) with mean GA of 38.1 in group 1 (in situ group) versus 37.8 in group 2 (exteriorized group). Patients were matched also as regards parity and all of the patients were either Primigravida (PG) or Para 1 (P1). Most of the studied patients have no history of previous cesarean section (58% in group 1 versus 62% in group 2; p-value > 0.05). When assessing the indications of CS, it was that there is statistically insignificantly different among both groups. The most common indication was previous CS (42% among in situ group versus 38% among exsteriorized group; p-value > 0.05) followed by dystocia (38% among in situ group versus 30% among exteriorized group; p-value > 0.05). Difference between both treatment procedures as regards the intraoperative post-delivery complications was variable. Nausea was significantly more incident among exteriorized group (42% versus 20%; p-value < 0.05) and tachycardia was significantly more among exteriorized group (p < 0.05), vomiting was significantly different among both groups (p < 0.05) while hypotension, requirement of blood transfusion and estimated blood loss by hematocrit was insignificantly different (p > 0.05). Duration of uterine repair and duration of surgery was significantly shorter with exteriorized uterine repair (p-value < 0.05). However, statistically insignificant, incidence of nausea, vomiting, infection of surgical site at 7th and 15th days postoperatively were numerically more among patients treated with exteriorized uterine repair. Duration of hospital was significantly longer among patients of exteriorized group (p-value < 0.05).Conclusion: Exteriorization of uterus resulted in significantly less duration of uterine repair and duration of surgery, exteriorization did not result in significant reduction of incidence of intra- and post-operative complications and it increased the duration of hospital stay. So, it is not recommended for use whenever not indicated.