Uterine exteriorization versus intraperitoneal repair at caesarean section

After caesarean delivery of the fetus and placenta, the uterus may be placed outside the mother to facilitate repair of the uterine incision. The objective of this review was to assess the effects of exteriorisation of the uterus, compared to the effects of uterine closure within the abdominal cavity. We searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised and quasi-randomised trials of uterine exteriorisation for repair compared to intra-abdominal repair for pregnant women undergoing elective or emergency caesarean section. Two reviewers assessed trial quality and extracted the data. Two trials involving 486 women were included. Neither trial was methodologically strong. Exteriorisation made no significant difference to blood loss. Exteriorisation was associated with fewer post-operative febrile days (fever more than three days, odds ratio 0.40, 95% confidence interval 0.17 to 0.94) and a non-significant trend towards fewer infections. There was also a non-significant trend towards more nausea and vomiting when exteriorisation was done under regional analgesia. There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision.