Intra-abdominal saline irrigation at cesarean  section: a systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to examine the evidence guiding intraoperative saline irrigation at cesarean sections.


METHODS
We searched "cesarean sections", "pregnancy", "saline irrigation" and "randomized clinical trials" in ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, AJOL, MEDLINE, LILACS and CINAHL from inception of each database to April 2015. The primary outcomes were predefined as intraoperative nausea and emesis. The pooled results were reported as relative risk (RR) with 95% confidence interval (95% CI).


RESULTS
Three randomized trials including 862 women were analyzed. Intraoperative saline irrigation was associated with a 68% increased risk of developing intraoperative nausea (RR = 1.68, 95% CI 1.36-2.06), 70% increased risk of developing intraoperative emesis (RR = 1.70, 95% CI 1.28-2.25), 92% increased risk of developing post-operative nausea and 84% increased risk of using anti-emetics post-operatively (RR = 1.84, 95% CI 0.21-2.78) when compared with controls. There were no significant differences between intraoperative saline irrigation and no treatment for post-operative emesis (RR = 1.65, 95% CI 0.74-3.67), estimated blood loss, time to return of gastrointestinal function, postpartum endometritis (RR = 0.95, 95% CI 0.64-1.40), urinary tract infection and wound infection.


CONCLUSIONS
Intraoperative saline irrigation at cesarean delivery increases intraoperative and post-operative nausea, requiring increasing use of anti-emetics without significant reduction in infectious, intraoperative and postpartum complications. Routine abdominal irrigation at cesarean section is not supported by current data.
Ahizechukwu Chigoziem
AC
Eke
Ghadear Hussein
GH
Shukr
Tina Taissir
TT
Chaalan
Sereen Khaled
SK
Nashif
George Uchenna
GU
Eleje
D002585:Cesarean Section; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D007507:Therapeutic Irrigation / Q000009:adverse effects*