Less Nausea With Intraabdominal Uterine Repair


BANFF, ALTA. — Compared with extraabdominal uterine repair after cesarean section, the intraabdominal technique is associated with significantly less nausea and should be considered as the primary method for uterine repair, according to Dr. Jeanette Lager of the University of North Carolina at Chapel Hill.

“Uterine exteriorization is advantageous when exposure is difficult and many surgeons believe it is easier and more efficient,” said Dr. Lager, who presented her findings at the annual meeting of the Society of Obstetric Anesthesia and Perinatology. Opposition to uterine exteriorization centers on concerns about hemodynamic instability, possible trauma to the uterine structures, and the potential for increased nausea, she said.

In her double-blinded, randomized trial, Dr. Lager found no difference between the two techniques in hemodynamic stability and estimated blood loss, although the intraabdominal technique was associated with a slightly longer operative time. “However, the difference was 7 minutes from skin [incision] to skin [closure] and 1 minute for uterine closure, so one could argue whether this is actually clinically significant,” she commented.

In terms of nausea, measured on a visual analog scale (VAS) ranging from 0 to 10, with 0 representing no nausea, mean nausea scores were considerably less in the 35 patients randomized to intraabdominal repair (2.3), compared with the 36 who received external repairs (4.6), she said. In addition, the rate of moderate to severe nausea was significantly lower in the intraabdominal group (35% vs. 67%). The intraabdominal group also used fewer antiemetics (18% vs. 23%) although this was not statistically significant, and VAS pain scores also showed a nonsignificant trend favoring the intraabdominal group, Dr. Lager said.

“Nausea is one of the most common concerns during cesarean delivery, second only to pain, and can interfere with uterine repair” if the patient is retching, she said, noting that according to an informal review at her hospital, 40% of women are pretreated or require treatment for nausea intraoperatively.

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