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Cesarean section is one of the oldest surgical interventions in the history of medicine.Many variations in cesarean section technique have been studied.The investigatory team are aiming to decrease blood loss during cesarean section by vertical splitting versus transverse cutting of muscle layer in lower segment cesarean sections to avoid uterine vessels injury.
Cesarean section is one of the oldest surgical interventions in the history of medicine.Since the first documented cesarean delivery in 1020 AD, various modifications have been made in the technique. It was a surgery performed as a last resort, mostly peri- or post-portem.
Many variations in cesarean section technique have been studied.our study aim is to decrease blood loss during cesarean section through decreasing incidence of uterine vessels injury. The investigator supposed that applying Vertical pull on a small C-shaped incision in the lower uterine segment during cesarean section allows the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transverse splitting | Active Comparator | transverse cutting and/or pulling of lower uterine segment during lower segment cesarean section. |
|
| Vertical splitting | Active Comparator | vertical splitting,of lower uterine segment during lower segment cesarean section. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transverse cutting | Procedure | Transverse cutting and/or pulling.of lower uterine segment during lower cesarean section extending the uterine incision laterally. |
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| Measure | Description | Time Frame |
|---|---|---|
| Uterine vessels injury | the surgeon performing the cesarean section will detect if injury of uterine vessels occurred or not while extending uterine incision. | 1 minute after extraction of the baby and placenta |
| Measure | Description | Time Frame |
|---|---|---|
| uterine incision extension | the surgeon performing the cesarean section will detect if uterine incision extension occurred or not after extraction of the baby and the placenta. | 2 minutes extraction of the baby and placenta |
| intra-operative blood loss |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Waled Hitler, Prof | AinShams University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ahmed Abass | Cairo | 11311 | Egypt |
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| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
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| vertical splitting | Procedure | vertical splitting of lower uterine segment during lower cesarean section making the direction of traction up and downward instead of being laterally and we suppose that this will allow the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery. |
|
blood loss will be assessed by circulating nurse through counting soaked surgical towels and gauze and calculating estimated blood loss in vacation suction system. |
| before closure of the abdominal wall layer |
| postpartum hemorrhage | will be defined by postpartum blood loss of 1000cc | first 24 hours after delivery |
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain after delivery | 2 hours after delivery |
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 6 hours after delivery |
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 12 hours after delivery |
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 24 hours after delivery |