Pregnancy Clinical Trial
Official title:
Intrauterine Cleaning After Delivery of Placenta During Cesarean Section
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"
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
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