///2014 Abstract Details
2014 Abstract Details2018-05-01T17:57:50+00:00

Exteriorization compared to in situ uterine repair for cesarean delivery: a systematic review and meta-analysis

Abstract Number: MA-01
Abstract Type: Meta Analysis/Review of the Literature

Valerie Zaphiratos MSc, MD, FRCPC1 ; John C. Boyd MSc2; Ronald B. George MD, FRCPC3; Ashraf S. Habib MB, ChB, MSc, MHS, FRCA4

Cesarean delivery (CD) is one of the most common surgical procedure performed in the world. The optimal surgical technique to limit maternal morbidity is debatable. One aspect of this debate relates to the method of uterine repair following delivery. Proponents of uterine exteriorization (UE) claim better surgical visualization, faster repair, and better control of hemostasis, whereas those who favor in situ (IS) repair are concerned about uterine traction causing nausea, vomiting, pain, hemodynamic instability, and trauma and infection to the surrounding structures. We performed a systematic review of randomized controlled trials (RCTs) to compare UE versus IS repair during CD on maternal complications. METHODS: This review adhered to PRISMA guidelines. CENTRAL, MEDLINE (PubMed), EMBASE, and CINAHL were systematically searched. The MeSH term for CD and its different spellings were combined with text searches for “repair”, “uterus”, “exteriorization”. The results of these searches were combined with a sensitive methodological filter for RCTs, meta-analyses, and systematic reviews. Primary outcomes sought included incidence of intraoperative complications (nausea, vomiting, pain), blood loss (reduction in hemoglobin, estimated blood loss) and postoperative infection (endometritis, wound infection). Secondary outcomes included operative time, hospital stay, blood transfusion, fever, postoperative pain, and return of bowel function. Studies were included if they reported any of the primary outcomes. RESULTS: Sixteen RCTs were selected for in-depth full-text review, from which 14 were deemed low-risk of bias and included in this systematic review. A total of 9077 subjects underwent UE, while 9054 subjects had IS repair. Endometritis pooled results showed a significant difference favoring IS repair. There was a significant difference favoring IS repair for return of bowel function. Although there was a tendency to favor UE for estimated blood loss, this was not significant. The data for intraoperative pain is inadequate to reach a conclusion due to the wide confidence intervals. Pooled results of the two repair techniques did not show a difference in intraoperative nausea or vomiting, drop in hemoglobin, wound infection, operative time, hospital stay, blood transfusion, and fever. DISCUSSION: We found that IS repair may be associated with less endometritis and faster return of bowel function. More well conducted randomised controlled trials are needed that focus specifically on intraoperative complications such as nausea, vomiting and hemodynamic instability. References: Cochrane Database Syst Rev 2004 (4): CD000085, Am J Obstet Gynecol 2009 200: 625 e621-628, Ann Intern Med 2009 151: 264-269, W264

SOAP 2014