Extra Abdominal versus Intra Abdominal Uterine Repair: a Randomized Control Trial

Objective: To compare extra-abdominal vs intra-abdominal repair of the uterine incision at cesarean delivery in Pakistan. Methods: This was a randomized controlled trial conducted at the Gynae Unit III, Lady Willingdon hospital Lahore. Inclusion criteria were indication for cesarean delivery and gestational age of 36 weeks or more in primigravidas. Patients with previous cesarean deliveries, chorioamnionitis, antipartum hemorrhage, pregnancy induced hypertension, diabetes, previous abdominal surgery were excluded. Different variables analyzed were post operative fever, vomiting, mean operative time, intraoperative blood loss, postoperative pain, number of postoperative analgesic doses and surgical site infection. Results: The analysis included 100 patients randomized each for exteriorized uterine repair and patients in situ uterine repair. A significant difference was observed in duration of surgery: lasting less than 45 minutes (46% with exteriorized uterus compared with 34.3% with in situ uterus, P=.03; and number of sutures required (18.6% requiring one suture in the exteriorized group compared with 12.5% in the in situ group, P=.02. The frequency of moderate or severe pain 6 hours after surgery was higher in women with exteriorized repair (23.0%) when compared with those who underwent in situ repair (32.4%) (P=.025). There was no difference between the groups in relation to other variables. Conclusion: There is no significant difference between extra-abdominal and intra-abdominal repair of the uterine incision at cesarean delivery, but the number of sutures required 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.