Effects of method of uterine repair on surgical outcome of cesarean delivery

Objective

To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery.

Methods

In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n = 2462) or extra-abdominal (n = 2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection.

Results

Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P = 0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P = 0.001, P = 0.002, P = 0.001, and P = 0.003, respectively).

Conclusion

Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.