title: Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare perioperative outcomes following uterine exteriorization vs in situ repair after Cesarean delivery.
  
  
  METHODS
  We searched CENTRAL, MEDLINE®, EMBASE™, CINAHL, and ClinicalTrials.gov for randomized clinical trials that included any of our primary outcomes (blood loss, intraoperative nausea, vomiting, and pain), or secondary outcomes.
  
  
  RESULTS
  Sixteen studies were included. In total, 9,736 subjects underwent exteriorization, 9,703 had in situ uterine repair. Estimated blood loss was not statistically different between the two methods of uterine repair (mean difference [MD], -61.03 mL; 95% confidence interval [CI], -127.34 to 5.28); however, exteriorization reduced the decrease in hemoglobin (MD, -0.14 g·dL(-1); 95% CI, -0.22 to -0.07). Estimated blood loss was reduced with exteriorization in a sensitivity analysis that excluded an outlier study. There was no statistically significant difference in intraoperative nausea (odds ratio [OR], 0.99; 95% CI, 0.74 to 1.34), vomiting (OR, 0.94; 95% CI, 0.66 to 1.35), or pain (OR, 1.52; 95% CI, 0.86 to 2.71) between the two repair techniques. In situ repair was associated with faster return of bowel function (MD, 3.09 hr; 95% CI, 2.21 to 3.97). An association between exteriorization and endometritis did not reach statistical significance (OR, 1.25; 95% CI, 0.96 to 1.62).
  
  
  CONCLUSIONS
  Uterine repair by exteriorization may reduce blood loss and the associated decrease in hemoglobin, but the difference may not be clinically relevant. There was no statistically significant difference between the two repair techniques for intraoperative nausea, vomiting, or pain. In situ repair may be associated with a faster return of bowel function.
authors: Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada.
authors: Valerie
authors: V
authors: Zaphiratos
authors: Department of Women's & Obstetric Anesthesia¸ IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada. rbgeorge@dal.ca.
authors: Ronald B
authors: RB
authors: George
authors: Department of Women's & Obstetric Anesthesia¸ IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada.
authors: J Colin
authors: JC
authors: Boyd
authors: Duke University Medical Center, Durham, NC, USA.
authors: Ashraf S
authors: AS
authors: Habib
mesh_terms: D016063:Blood Loss, Surgical; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D013536:Suture Techniques; D014599:Uterus / Q000601:surgery*