Is it better to leave the uterus in the abdominal cavity or exteriorize it following C-section?
A large meta-analysis addressed the question as to whether it is better to exteriorize the uterus or leave the uterus in the abdomen when closing the uterine incision. The main benefit of exteriorization is improved visualization while some surgeons also claim improved blood loss. Conversely, there are concerns regarding increased infection with exteriorization, as well as patient discomfort. The authors found the following:
Drop in hemoglobin was less with exteriorization (mean difference -0.14g dL) but no statistical difference in estimated blood loss
Faster return to bowel function when the uterus was left in situ (mean difference 3.09 hours).
No statistical difference in intraoperative nausea, vomiting, pain or endometriosis
This meta-analysis by Zaphiratos and colleagues (Can J Anaesth, 2015) considered 16 randomized trials that assessed outcomes in 19,439 women; 9,736 subjects had the uterus closed externally and 9,703 women had their repair performed in situ. The primary outcome measures were blood loss, intraoperative nausea, vomiting and pain.
There may be some benefits associated with each approach
There does not appear to be any major differences between the primary outcome measures that were assessed
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