A randomised, controlled study of uterine exteriorisation and repair at caesarean section

Objective To determine the surgical and anaesthetic benefits and problems a ssociated with the practice of routine exteriorisation of the uterus to fac ilitate repair at caesarean section. Design A randomised controlled study of women undergoing caesarean section. After establishment of anaesthesia, women were randomised to either exteri orisation and uterine repair or suture of the uterus in the abdomen. Setting A maternity hospital in the United Kingdom. Main outcome measures Peri-operative haemoglobin change, duration of operat ion, maternal morbidity and length of hospital stay. Intra-operative pain, nausea, vomiting, pulling or tugging sensations were secondary outcome meas ures. Results Three hundred and sixteen women were randomised, of whom 288 were s ubsequently analysed (139 women in whom the uterus was exteriorised and 149 where the uterus was not exteriorised). Exteriorisation of the uterus, an elective caesarean section and a spinal or general anaesthesia each had a s tatistically significant association with reduced blood loss (P < 0.05). Th ere were no statistically significant differences between the two groups wi th regard to intra-operative complications or pain, nor were there any stat istically significant difference in post-operative wound sepsis, pyrexia, d eep vein thrombosis, blood transfusion or length of hospital stay. Conclusion With effective anaesthesia, exteriorisation of the uterus for re pair following caesarean delivery is not associated with significant proble ms and is associated with less blood loss.