Comparison of Uterine Repair Methods for Cesarean Delivery

Randomized Controlled Trial of Uterine Exteriorization Versus in Situ Repair for Elective Cesarean Delivery

This study is designed to compare the exteriorization of the uterus versus the in situ repair for closure of the hysterotomy incision with a completely standardized anesthetic protocol.

Two well-known uterine repair techniques are described; the uterus can be repaired in situ within the peritoneal cavity (intraabdominal) or exteriorized temporarily from the abdomen for the closure of the hysterotomy incision (extraabdominal). 3 meta-analysis on the topic were unable to demonstrate the superiority of one technique regarding maternal morbidities. However, there is a paucity of studies with a standardized anesthetic protocol evaluating these outcomes.

This study will evaluate the impact of the uterine repair technique on different maternal morbidities; focusing on intra-operative nausea and vomiting under a standardized anesthetic protocol.

Inclusion Criteria:

• Elective cesarean delivery
• Term gestation, 37 weeks or more
• Healthy parturients (ASA 1 and 2)
• Spinal anesthesia

Exclusion Criteria:

• Conditions at risk of uterine atony and/or postpartum hemorrhage (multiple gestation, placenta accrete / previa, pre-eclampsia / eclampsia, uterine leiomyomata, polyhydramnios)
• Morbid obesity (BMI > 35 kg / m2) at delivery
• Coagulopathy
• Active labor
• Cardiomyopathy
• Emergency cesarean section
• Refusal/Inability to consent
• Language other than English or French