C Wilkinson1, M W Enkin. 1. Department of Perinatal Medicine/University Department of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, Australia, 5006. cwilkins@medicine.adelaide.edu.au
Abstract
BACKGROUND: After caesarean delivery of the fetus and placenta, the uterus may be placed outside the mother to facilitate repair of the uterine incision. OBJECTIVES: The objective of this review was to assess the effects of exteriorisation of the uterus, compared to the effects of uterine closure within the abdominal cavity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of uterine exteriorisation for repair compared to intra-abdominal repair for pregnant women undergoing elective or emergency caesarean section. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted the data. MAIN RESULTS: Two trials involving 486 women were included. Neither trial was methodologically strong. Exteriorisation made no significant difference to blood loss. Exteriorisation was associated with fewer post-operative febrile days (fever more than three days, odds ratio 0.40, 95% confidence interval 0.17 to 0.94) and a non-significant trend towards fewer infections. There was also a non-significant trend towards more nausea and vomiting when exteriorisation was done under regional analgesia. REVIEWER'S CONCLUSIONS: There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision.
BACKGROUND: After caesarean delivery of the fetus and placenta, the uterus may be placed outside the mother to facilitate repair of the uterine incision. OBJECTIVES: The objective of this review was to assess the effects of exteriorisation of the uterus, compared to the effects of uterine closure within the abdominal cavity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of uterine exteriorisation for repair compared to intra-abdominal repair for pregnant women undergoing elective or emergency caesarean section. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted the data. MAIN RESULTS: Two trials involving 486 women were included. Neither trial was methodologically strong. Exteriorisation made no significant difference to blood loss. Exteriorisation was associated with fewer post-operative febrile days (fever more than three days, odds ratio 0.40, 95% confidence interval 0.17 to 0.94) and a non-significant trend towards fewer infections. There was also a non-significant trend towards more nausea and vomiting when exteriorisation was done under regional analgesia. REVIEWER'S CONCLUSIONS: There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision.