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Uterus in or out?From: RModugno@aol.comSat Oct 20 10:12:18 2007
Sometimes I do 'em in, sometimes I do 'em out depending on the circumstances. Complications of exteriorized compared with in situ uterine repair at cesarean delivery under spinal anesthesia: a randomized controlled trial. _Obstet Gynecol. 2007; 110(3):570-5_ (http://www.medscape.com/medline/publicationbrowser/123?pmid=17766602) (ISSN: 0029-7844) Siddiqui M; Goldszmidt E; Fallah S; Kingdom J; Windrim R; Carvalho JC Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Onatario, Canada. OBJECTIVE: To compare intraoperative complications of exteriorized and in situ uterine repair during elective cesarean delivery under spinal anesthesia. METHODS: This study was a randomized, single-blinded trial in 80 women undergoing elective cesarean delivery under spinal anesthesia. Patients were randomly assigned to exteriorized or in situ uterine repair. Obstetricians were asked to perform assisted delivery of the placenta. Spinal anesthesia and oxytocin management were standardized. Phenylephrine was used to maintain systolic blood pressure within 10% of the baseline. The primary outcome was intraoperative, postdelivery nausea or vomiting. RESULTS: Postdelivery nausea or vomiting (18% compared with 38%; P=.04) and tachycardia (3% compared with 18%; P=.03) were significantly reduced in the in situ group compared with the exteriorized group. The duration of uterine repair was significantly shorter in the exteriorized group (median 10 minutes [first and third quartiles 9, 13], compared with 11 minutes [9, 15]) (P=.04). The duration of surgery (36 minutes [30, 41] compared with 37 minutes [30, 45]) and estimated blood loss (mean+/-standard deviation 625+/-489 mL compared with 653+/-416 mL) were similar between the in situ and the exteriorized groups. There was no correlation between duration of uterine repair and estimated blood loss. CONCLUSION: Exteriorization of the uterus for repair is associated with an increased incidence of nausea and vomiting and tachycardia during cesarean delivery under spinal anesthesia. Uterine repair should be done in situ where possible. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT00452972 LEVEL OF EVIDENCE: I. ************************************************************* Robert Modugno MD MBA FACOG Sylva, NC ************************************** See what's new at http://www.aol.com -------------------------------1192893122 Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> Sometimes I do 'em in, sometimes I
do 'em out depending on the circumstances.
Complications of exteriorized compared with in situ uterine repair at cesarean delivery under spinal anesthesia: a randomized controlled trial.Obstet Gynecol. 2007; 110(3):570-5 (ISSN: 0029-7844)Siddiqui M;
Goldszmidt E; Fallah S; Kingdom J; Windrim R;
Carvalho JC OBJECTIVE: To compare intraoperative complications of exteriorized and in situ uterine repair during elective cesarean delivery under spinal anesthesia. METHODS: This study was a randomized, single-blinded trial in 80 women undergoing elective cesarean delivery under spinal anesthesia. Patients were randomly assigned to exteriorized or in situ uterine repair. Obstetricians were asked to perform assisted delivery of the placenta. Spinal anesthesia and oxytocin management were standardized. Phenylephrine was used to maintain systolic blood pressure within 10% of the baseline. The primary outcome was intraoperative, postdelivery nausea or vomiting. RESULTS: Postdelivery nausea or vomiting (18% compared with 38%; P=.04) and tachycardia (3% compared with 18%; P=.03) were significantly reduced in the in situ group compared with the exteriorized group. The duration of uterine repair was significantly shorter in the exteriorized group (median 10 minutes [first and third quartiles 9, 13], compared with 11 minutes [9, 15]) (P=.04). The duration of surgery (36 minutes [30, 41] compared with 37 minutes [30, 45]) and estimated blood loss (mean+/-standard deviation 625+/-489 mL compared with 653+/-416 mL) were similar between the in situ and the exteriorized groups. There was no correlation between duration of uterine repair and estimated blood loss. CONCLUSION: Exteriorization of the uterus for repair is associated with an increased incidence of nausea and vomiting and tachycardia during cesarean delivery under spinal anesthesia. Uterine repair should be done in situ where possible. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT00452972 LEVEL OF EVIDENCE: I. *************************************************************
Robert
Modugno MD MBA FACOG
Sylva,
NC See what's t="_blank">Make AOL Your Homepage.
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