Comparative study between uterine exteriorization and Insitu Repair at cesarean section

INTRODUCTION: Cesarean is one of the oldest and most commonly performed procedures in obstetrics. This procedure has saved the lives of countless mothers and fetuses in helpless situations. On the other hand, its inappropriate use can be a direct and preventable cause of maternal morbidity and mortality. With immense advances in anaesthesia, improvements in surgical techniques, availability of antibiotics and blood products, the safety of lower uterine segment cesarean, broadening of indications for cesarean, recognition of fetus as a patient, the feasibility of vaginal birth after cesarean and the acceptance of the procedure by women have characterized the evolution of cesarean during the 20th and the 21st century. From the early 21st century, the choice for women on the mode of delivery has further added to the evolution of increasing cesarean rates. On the other hand it has simultaneously led to decrease in maternal morbidity and mortality due to the anaesthetic and technical improvements. This has driven many obstetricians to perform more and more cesarean. The increase in cesarean rates has hit both the developed and developing countries. AIM OF THE STUDY: To compare the influence of the two methods of cesarean- exteriorisation and insitu repair of the uterus on cesarean morbidity. Materials and Methods: Study Design: Randomised prospective study. Study Period: 1 YEAR (2011-2012). Setting: Institute of Obstetrics and Gynecology, Egmore, Chennai. Population: 200 subjects undergoing primary cesarean for delivery Inclusion Criteria: 1. Primi undergoing LSCS, 2. Multigravida undergoing first LSCS. Exclusion Criteria: 1. Placenta previa, 2. Abruptio placenta 3. Anemia – Hb <11g/dl, 4. Previous caesarean, 5. Multiple pregnancy, 6. Chorioamnionitis, 7. Rupture uterus, 8. Obstructed labour, 9. Prolonged rupture of membranes. CONCLUSION: We have found that the technique of uterine exteriorisation during cesarean is associated with less drop in postoperative hemoglobin levels which indicates less blood loss intraoperatively. We have also demonstrated that the time taken for surgery is significantly less in the exteriorized group when compared to in situ group. Other morbidities are similar in both the techniques. Hence, with good preoperative preparation, effective anaesthesia, surgeon’s experience with the technique, the method of uterine exteriorisation is a valuable option. However caution should be excised in cases of antepartum hemorrhage