Difference Between Pre- and Post-operative CBC Clinical Trial
Official title:
Evaluation of the Effects of Extra-abdominal Removal of the Placenta During Cesarean Section on the Amount of Bleeding Into the Abdominal Cavity.
During cesarean section, it is important to provide hemostasis as well as to decrease the amount of hemorrhagic fluid and fibrin in the abdominal cavity. Hemorrhagic fluid and fibrin together may cause adhesion formation and therefore postoperative ileus, retardation in regaining the gastrointestinal functions as well as prolongation of the operation itself. Dragging the uterus out of the abdominal cavity during cesarean section before removing the placenta (extra-abdominal removal of the placenta) may decrease the amount of blood flowing into the abdominal cavity during removal of placenta. In this study the investigators aimed to evaluate the influence of intra abdominal vs extra abdominal removal of placenta on duration of operation, the amount of aspirated fluid during the operation, difference between postoperative hemoglobin and hematocrit levels, postoperative pain score, additional need of analgesia, postoperative bowel movements, postoperative endometritis and wound infection.
In this study the investigators will recruit 200 pregnant women; 100 women in the study
group and 100 women in the control group. The women will be randomly allocated in two
groups. The odd numbered women will be in the study group and even numbered women will be in
the control group.
The investigators will perform cesarean section according to the obstetrical indications.
Lower segment uterine incision will be used during the cesarean section. After the delivery
of the fetus two distinct procedures will be used in the control and study groups.
In the control group, the uterus will be left in the abdominal cavity and the placenta will
be manually removed with uterine massage as soon as possible. After removal of the placenta,
the uterus will be dragged out of the abdominal cavity. The cesarean incision will be
sutured with no. 1 Vicryl ®. Uterus will be replaced in the abdominal cavity.
Intra-abdominal cavity will be cleaned by aspirator and mounted-gauze tampon. The weight of
the placenta will be measured. The weight of the gauze tampons will be measured with
gravimetric method before and after use.
In the study group, at first, the uterus will be dragged out of the abdominal cavity, prior
to removal of the placenta. The placenta will be manually removed with uterine massage as
soon as possible. The cesarean incision will be sutured with no. 1 Vicryl ®. Uterus will be
replaced in the abdominal cavity. Intra-abdominal cavity will be cleaned by aspirator and
mounted-gauze tampon. The weight of the placenta will be measured. The weight of the gauze
tampons will be measured with gravimetric method before and after use.
In both groups, the abdominal cavity will be closed as appropriate. The vital signs (blood
pressure and heart rate) will be monitored. Postoperative blood samples for complete blood
count (CBC) will be taken 24 hours after the operation. Bowel movements will be assessed
every 6 hours by a stethoscope. Time of the first flatulence will be recorded. Visual Analog
Scoring (VAS) survey validated in Turkey will be performed in the postoperative 1. and 2.
days. The type and amount of postoperative analgesics will be recorded. The body temperature
will regularly be assessed in the first 24. and 48. hours. The presence of fever will be
recorded.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention