title: Effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: does it have any effect on postoperative vital signs? A prospective randomized study.
abstract: OBJECTIVE
  To investigate the effect of peritonization at cesarean section on postoperative vital signs which was thought to be an indirect finding secondary to increased sympathetic activity originated from pain caused by stretched peritoneum.
  
  
  METHODS
  One hundred and thirty-three pregnant women were randomized to four groups; Closure of parietal peritoneum only (group 1; n = 32), closure of visceral and parietal peritoneums (group 2; n = 32), no closure of peritoneums (group 3; n = 32) and closure of the visceral peritoneum only (group 4; n = 32). All participants were monitored for blood pressure, pulse activity and hourly urinary output during the first postoperative 24 h. Postoperative pain was measured using a Visual Analogue Scale 6th and 24th hours after surgery. Return of bowel function was measured from the end of the operation to the first passage of flatus. Operating time, pre- and postoperative hemoglobin, postoperative complications, length of hospital stay and postoperative urine osmolarity were noted.
  
  
  RESULTS
  The mean surgery duration was significantly longer in group 2. Diuresis was found significantly decreased in group 2. Pulse rate and systolic and diastolic blood pressure were significantly higher in group 2. Closure of both peritoneums was associated with higher post-operative pain as assessed using Visual analogue scale score analyses in group 2.
  
  
  CONCLUSIONS
  Both visceral and parietal membrane closure in cesarean section should be avoided in women with hypertensive disorders, renal function abnormalities and autonomic dysfunction because of increased postoperative pain and associated sympathetic overactivity.
authors.affiliation: a Obstetric and Gynecology Department, Adnan Menderes University Medical Faculty , Aydin , Turkey.
authors.forename: Meryem
authors.initials: M
authors.lastname: Kurek Eken
authors.affiliation: b Zeynep Kamil Maternity and Children Hospital, Obstetric and Gynecology Department , İstanbul , Turkey , and.
authors.forename: Enis
authors.initials: E
authors.lastname: Özkaya
authors.affiliation: c Medipol University Medical Faculty Sefaköy Hospital , Istanbul , Turkey.
authors.forename: Tuba
authors.initials: T
authors.lastname: Tarhan
authors.affiliation: b Zeynep Kamil Maternity and Children Hospital, Obstetric and Gynecology Department , İstanbul , Turkey , and.
authors.forename: Şeyma
authors.initials: Ş
authors.lastname: İçöz
authors.affiliation: b Zeynep Kamil Maternity and Children Hospital, Obstetric and Gynecology Department , İstanbul , Turkey , and.
authors.forename: Şebnem
authors.initials: Ş
authors.lastname: Eroğlu
authors.affiliation: c Medipol University Medical Faculty Sefaköy Hospital , Istanbul , Turkey.
authors.forename: Ş Tuğba
authors.initials: ŞT
authors.lastname: Kahraman
authors.affiliation: b Zeynep Kamil Maternity and Children Hospital, Obstetric and Gynecology Department , İstanbul , Turkey , and.
authors.forename: Ateş
authors.initials: A
authors.lastname: Karateke
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D010149:Postoperative Pain; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011184:Postoperative Period; D011247:Pregnancy; D014781:Viscera / Q000601:surgery*; D055986:Vital Signs; D055815:Young Adult
keywords: Cesarean section; pain; peritoneum; sympathetic activity; vital signs