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Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis.

Publication ,  Journal Article
Zaphiratos, V; George, RB; Boyd, JC; Habib, AS
Published in: Can J Anaesth
November 2015

PURPOSE: To compare perioperative outcomes following uterine exteriorization vs in situ repair after Cesarean delivery. SOURCE: 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. PRINCIPAL FINDINGS: 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). CONCLUSION: 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.

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Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

November 2015

Volume

62

Issue

11

Start / End Page

1209 / 1220

Location

United States

Related Subject Headings

  • Uterus
  • Suture Techniques
  • Postoperative Complications
  • Humans
  • Female
  • Cesarean Section
  • Blood Loss, Surgical
  • Anesthesiology
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
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Zaphiratos, V., George, R. B., Boyd, J. C., & Habib, A. S. (2015). Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth, 62(11), 1209–1220. https://doi.org/10.1007/s12630-015-0448-2
Zaphiratos, Valerie, Ronald B. George, J Colin Boyd, and Ashraf S. Habib. “Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis.Can J Anaesth 62, no. 11 (November 2015): 1209–20. https://doi.org/10.1007/s12630-015-0448-2.
Zaphiratos V, George RB, Boyd JC, Habib AS. Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2015 Nov;62(11):1209–20.
Zaphiratos, Valerie, et al. “Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis.Can J Anaesth, vol. 62, no. 11, Nov. 2015, pp. 1209–20. Pubmed, doi:10.1007/s12630-015-0448-2.
Zaphiratos V, George RB, Boyd JC, Habib AS. Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2015 Nov;62(11):1209–1220.
Journal cover image

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

November 2015

Volume

62

Issue

11

Start / End Page

1209 / 1220

Location

United States

Related Subject Headings

  • Uterus
  • Suture Techniques
  • Postoperative Complications
  • Humans
  • Female
  • Cesarean Section
  • Blood Loss, Surgical
  • Anesthesiology
  • 1103 Clinical Sciences