PURPOSE:

• Dilatation of the cervix with the finger or instruments after placental removal is a common practice to drain blood and thereby limit infection and PPH
• There is a risk of introducing infection
• Kirscht et al. (Archives of Gynecology and Obstetrics, 2017) performed a randomized trial to determine the risks vs the benefits of this procedure

METHODS:

• DONDI trial (Dilatation or no dilatation of the cervix during cesarean section), a prospective, open-label, RCT (2011-2013)
  • Women blinded but not staff due to inability to blind intervention
  • Dilation performed using a Hegar dilator
• Elective cesarean section
• Exclusion Criteria: Current antibiotic therapy, chorioamnionitis, onset of labor with dilatation of the cervix and gestational age under 24 weeks of gestation
• Primary outcome
  • PPH (defined as blood loss ≥ 1000 ml) within 6 weeks
• Secondary outcomes
  • Retained products of conception (defined as necessity of oxytocin administration, cervical dilatation, or curettage within 6 weeks)
  • wound infections
  • endometritis
  • blood transfusions
  • hemoglobin changes
  • uterine subinvolution
  • puerperal fever
  • urinary tract infections
  • operating time

RESULTS:

• There were 205 women in the intervention group vs 242 in the control group
• When comparing the intervention group to the control group
  • Rate of PPH not statistically different (2.4 % vs 1.2%; P = 0.479)
  • Among other outcomes, the only significant finding was retained products of conception with fewer cases after cervical dilatation (0 versus 6.2 %, p < 0.001)
    • Did not result in increased rate of PPH

CONCLUSION:

• Authors note previous systematic reviews did not find evidence to support the use of mechanical dilation at cesarean section
  • However, previous studies did not necessarily include all outcome measures, such as PPH
• Due to finding of increased retained products of conception, authors suggest that mechanical dilation may still be an option and more RCTs are necessary to make a final recommendation

Learn More – Primary Sources:

Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial

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