Complications of exteriorized compared with in situ uterine repair at cesarean delivery under spinal anesthesia: a randomized controlled trial.
OBJECTIVE
To compare intraoperative complications of exteriorized and in situ uterine repair during elective cesarean delivery under spinal anesthesia.


METHODS
This study was a randomized, single-blinded trial in 80 women undergoing elective cesarean delivery under spinal anesthesia. Patients were randomly assigned to exteriorized or in situ uterine repair. Obstetricians were asked to perform assisted delivery of the placenta. Spinal anesthesia and oxytocin management were standardized. Phenylephrine was used to maintain systolic blood pressure within 10% of the baseline. The primary outcome was intraoperative, postdelivery nausea or vomiting.


RESULTS
Postdelivery nausea or vomiting (18% compared with 38%; P=.04) and tachycardia (3% compared with 18%; P=.03) were significantly reduced in the in situ group compared with the exteriorized group. The duration of uterine repair was significantly shorter in the exteriorized group (median 10 minutes [first and third quartiles 9, 13], compared with 11 minutes [9, 15]) (P=.04). The duration of surgery (36 minutes [30, 41] compared with 37 minutes [30, 45]) and estimated blood loss (mean+/-standard deviation 625+/-489 mL compared with 653+/-416 mL) were similar between the in situ and the exteriorized groups. There was no correlation between duration of uterine repair and estimated blood loss.


CONCLUSIONS
Exteriorization of the uterus for repair is associated with an increased incidence of nausea and vomiting and tachycardia during cesarean delivery under spinal anesthesia. Uterine repair should be done in situ where possible.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00452972


METHODS
I.
Siddiqui
Mughina
M
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Onatario, Canada.
Goldszmidt
Eric
E
Fallah
Shafagh
S
Kingdom
John
J
Windrim
Rory
R
Carvalho
Jose C A
JC
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology*; D010149:Postoperative Pain / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology*; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology; D016037:Single-Blind Method; D013610:Tachycardia / Q000453:epidemiology*; D013997:Time Factors; D014599:Uterus / Q000601:surgery*