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Uterine Exteriorisation Versus in Situ Repair for Elective Cesarean Delivery Using a Phenylephrine Infusion; a Randomized Controlled Trial
Abstract Number: GM-06
Abstract Type: Original Research
Introduction: During cesarean delivery (CD), the uterus can be repaired in situ within the peritoneal cavity or exteriorized from the abdomen. Neither of these two approaches have been deemed clearly superior.1–4 Only one randomized controlled trial (RCT) evaluated intraoperative nausea or vomiting (IONV) as a primary outcome with a standardized anesthetic technique.4 IONV is amongst the main concerns of women scheduled for elective CD.5 This study aims to compare the effect of these two uterine repair methods on maternal morbidity during elective CD.
Methods: This study was a prospective RCT of 180 healthy term parturients undergoing elective CD. Spinal anesthesia, uterotonics, infusion of phenylephrine and blood pressure management were all standardized. Patients were randomized to exteriorization (n=90) or in situ uterine repair (n=90). The primary outcome was postdelivery IONV assessed on a 4-point scale (0 none, 1 light, 2 severe, 3 vomiting) at the beginning of uterine and fascia repair as specific time points.
Results: From November 2015 through July 2018, 160 patients were included for analysis. Incidence of postdelivery IONV was 40.2% in the exteriorization group compared to 20.5% in the in situ group (P = 0.01). The severity of IONV was reduced with in situ repair (Chi-square test for trend, p = 0.005) (Figure). The exteriorization group required more phenylephrine boluses (Median [IQR]: 4 [1-6.25] vs 1.5 [0-4]; Mann-Whitney test, p = 0.0002). The duration of surgery (28.5 [24-35] vs 29 [25-34] minutes; p = 0.63), blood loss (Mean±SD: 669.5±133 vs 674.4±152 mL) and post-operative hemoglobin (103.1±14.7 g/L vs 103.1±12.4 g/L) were similar between groups.
Discussion: This is the first prospective randomized controlled trial studying uterine repair on IONV using a phenylephrine infusion. In situ uterine repair for elective CD significantly decreases IONV incidence and intensity, and causes less hemodynamic changes requiring intervention. In situ uterine repair minimizes maternal morbidity for elective CD.
1. Can J Anesth. 2015;62(11):1209-1220
2. Am J Obstet Gynecol. 2009;200(6):625.e1-625.e8
3. Cochrane Database Syst Rev. 2004;(4):CD000085d
4. Obstet Gynecol Surv. 2008;63(1):7-8
5. Anesth Analg. 2005;101(4):1182-1187