Pregnancy
Conditions
Brief summary
400 women who came to our Department for Cesarean Section delivery will be divided into 2 groups: Group1:Cleaning the uterine cavity 200 patients Group2:No Cleaning of uterine cavity 200 patients
Detailed description
Caesarean section is the most common major surgical procedure performed in obstetric practice. The American College of Obstetricians and Gynecologists (ACOG) estimates that in 2011 alone, one in three women who gave birth in the United States did so by cesarean delivery. Compared to vaginal births, the increasing rate of caesarean births worldwide is a well known cause of maternal morbidity, including hemorrhage, anesthetic complications, shock, cardiac arrest, acute renal failure, assisted ventilation, venous thromboembolism and increased risk of major postpartum infection. With increasing cesarean section rates and its associated complications, obstetricians are challenged to reduce perioperative and postoperative morbidity by adapting their surgical skills and techniques. Over the years, randomized clinical trials have tried to answer many questions surrounding the safety of several cesarean section techniques that impart maternal morbidity. For example, the optimal type of cesarean section skin incision, whether or not to create a bladder flap, one layer versus two later closure of the uterus, irrigating the abdominal cavity, closure versus non closure of the parietal peritoneum, and suture versus staples for skin closure at cesarean section. Cleaning the uterine cavity following cesarean section is a routine practice by many obstetricians. To ensure that the entire placenta and membranes are removed after delivery of the placenta at cesarean, the uterine cavity is usually cleaned with one hand holding a dry sponge to remove any remaining membranes or placental tissue, while the other hand is placed on the fundus to stabilize the uterus. However, despite the lack of evidence to support a policy of routine intrauterine cleaning after placental delivery at cesarean section, the benefits of intrauterine cleaning as a routine practice during cesarean sections remains uncertain. Obstetricians who do not routinely clean the uterine cavity after placental delivery argue that this procedure is not performed routinely after vaginal deliveries, and thus is a justification not to do so during cesarean sections
Interventions
PROCEDURECleaning of uterine cavity
Procedure: Cleaning the uterine cavity These participants will have their uterine cavities cleaned with a dry laparotomy sponge after delivery of the placenta. Per standard protocol, the uterus will be explored with one hand holding a sponge to remove any remaining membranes or placental tissue, while the other hand is placed on the fundus to stabilize the uterus
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* women age from 20 to35 years old with intact membrane women with singleton or multiple pregnancy women with cephalic or breech presentation
Exclusion criteria
* premature rupture of membranes chorioamnionitis Diabetes mellitus Immunosuppressive disorder or therapy Fetal demise
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postpartum endometritis | Within weeks | Endomyometritis after delivery \[ Time Frame: Within 6 weeks after delivery \] Endomyometritis will be diagnosed by the presence of two or more of the following: abnormally tender uterus on examination, temperature more than 38.0°C at any time postoperatively, and unexplained maternal tachycardia more than 100 beats per minute (bpm). A diagnosis of endomyometritis will be criteria for initiating treatment with antibiotics. Endomyometritis after delivery \[ Time Frame: Within 6 weeks after delivery \] Endomyometritis will be diagnosed by the presence of two or more of the following: abnormally tender uterus on examination, temperature more than 38.0°C at any time postoperatively, and unexplained maternal tachycardia more than 100 beats per minute (bpm). A diagnosis of endomyometritis will be criteria for initiating treatment with antibiotics. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Primary postpartum hemorrhage | Within 6 weeks | Post partum hemorrhage \[ Time Frame: Within 6 weeks after delivery \] Mean surgical time \[ Time Frame: Immediately post cesarean \] Calculated blood loss \[ Time Frame: Within 6 weeks post delivery \] Hospital length of stay \[ Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 4 days postpartum \] Return of gastrointestinal function \[ Time Frame: Participants will be followed for the duration to return of bowel function, an expected average of 2 days postpartum \] Repeat surgery \[ Time Frame: Within 6 weeks post delivery \] Hospital readmission rates. \[ Time Frame: Within 6 weeks post delivery \] |
Countries
Egypt
Contacts
Primary ContactDr yasser Abou talib, Professor
Backup ContactDr ahmed Hussein, Lecturer
Outcome results
None listed