title: Uterine exteriorization compared with in situ repair at cesarean delivery: a randomized controlled trial.
abstract: OBJECTIVE
  To compare extra-abdominal to intra-abdominal repair of the uterine incision at cesarean delivery.
  
  
  METHODS
  This is a randomized controlled trial conducted at the Instituto Materno-Infantil Prof. Fernando Figueira (Recife, Brazil). Inclusion criteria were indication for cesarean delivery and gestational age of 24 weeks or more. Patients with two or more cesarean deliveries, chorioamnionitis, hemorrhage, inability to consent, and previous abdominal surgery were excluded. Variables analyzed were nausea, vomiting, mean operative time, intraoperative blood loss, number of surgical sutures for uterine repair, postoperative pain evaluated by the visual analog scale, number of postoperative analgesic doses, surgical site infection, and endometritis.
  
  
  RESULTS
  The analysis included 325 patients randomized for exteriorized uterine repair and 312 patients randomized for in situ uterine repair. A significant difference was observed in duration of surgery: lasting less than 45 minutes (44% with exteriorized uterus compared with 35.3% with in situ uterus, P=.02; number needed to treat=12) and less need of sutures (18.2% requiring one suture in the exteriorized group compared with 11.9% in the in situ group, P=.03; number needed to treat=16). The frequency of moderate or severe pain 6 hours after surgery was low [corrected] in women with in situ [corrected] repair (23.1%) when compared to those with the uterus exteriorized [corrected] (32.6%) (P=.026; number needed to treat=11). There was no difference between the groups in relation to other variables.
  
  
  CONCLUSIONS
  There is no significant difference between extra-abdominal and intra-abdominal repair of the uterine incision at cesarean delivery, but the number of sutures is lower and surgical time is shorter with extra-abdominal repair, although moderate and severe pain at 6 hours is less frequent with in situ uterine repair.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT00550888.
authors.affiliation: Instituto Materno-Infantil Prof. Fernando Figueira (IMIP); and Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
authors.forename: Isabela Cristina
authors.initials: IC
authors.lastname: Coutinho
authors.forename: Melania Maria
authors.initials: MM
authors.lastname: Ramos de Amorim
authors.forename: Leila
authors.initials: L
authors.lastname: Katz
authors.forename: Alvaro Antônio
authors.initials: AA
authors.lastname: Bandeira de Ferraz
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D016017:Odds Ratio; D010149:Postoperative Pain; D011247:Pregnancy; D013530:Surgical Wound Infection; D013536:Suture Techniques