Does uterine wiping influence the rate of post-Cesarean endometritis?

Postpartum endometritis after uterine cleaning versus no cleaning in cesarean sections: Randomized clinical trial

AIM

The aim of the study was to compare the rates of postpartum endometritis due to uterine cleaning and no cleaning in patients delivered by elective cesarean section.

METHODS

This was a randomized clinical trial conducted at the Obstetrics and Gynecology Department, Suez Canal University Hospital, Ismailia, from June 2019 to November 2019. We recruited patients undergoing cesarean delivery aged 18-45 years with singleton pregnancy, intact membranes, either first or repeated delivery, without labor pains. Patients were allocated into two groups, uterine cleaning (336 patients) and no cleaning (312 patients). The main outcome measure was the occurrence of postpartum endometritis.

RESULTS

Both groups were matched in their demographic characters. Twelve patients (3.6%) developed endometritis in the cleaning group versus one patient (0.3%) in the other one. Estimated blood loss was 754.35 ± 247.13 and 730.36 ± 232.77 for the cleaning and no cleaning groups, respectively, with a P value of 0.201. Septic wound infection (21 patients, 6.3%) was predominant in the cleaning group.

CONCLUSION

Uterine cleaning after delivery of the placenta during CS can be omitted as a surgical step during the operation. It was associated with increased rates of postpartum endometritis and blood loss.

Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial

OBJECTIVE

To compare blood loss with spontaneous delivery and manual removal of the placenta during caesarean section.

DESIGN

A randomised controlled trial.

SETTING

Four university hospitals between September 1999 and June 2002.

POPULATION

A total of 472 women delivering by caesarean section at term were randomised to spontaneous placental delivery (n= 235) or manual removal (n= 237).

METHODS

The allocation was made by opening the next available of a series of sealed opaque envelopes and derived from a computer-generated list of numbers.

MAIN OUTCOME MEASURES

Significant blood loss, defined as either a drop in haemoglobin of greater than 2.5 g/dL, or the need for blood transfusion.

RESULTS

The mean interval between delivery of the newborn and the placenta was longer in the spontaneous delivery group (3.4 vs 1.9 minutes), but the mean duration of the operation was similar. Significant blood loss occurred in 30 women (13%) in the spontaneous delivery group and 49 women (21%) in the manual removal one (RR 0.62; 95% CI 0.41-0.94). Post-operative fever affected 6 and 5 cases, respectively, and antibiotics were used in 14 and 12 cases, respectively.

CONCLUSIONS

Allowing spontaneous delivery of the placenta reduces significant blood loss without increasing operating time.