Exteriorization of uterus before placental expulsion and intra-myometrial oxytocin versus in situ repair and IV oxytocin during LSCS-A comparative study

A suitable modification of any step of caesarean section to reduce blood-loss should be considered as the morbidity and mortality of CS is mostly associated with excessive hemorrhage.

This is a comparative study of uterine exteriorization and intra-myometrial (IMM) oxytocin 5 IU before placental expulsion with conventional method of intra-abdominal repair with 10 IU IV oxytocin with primary objective to compare the blood-loss.

A prospective study of 2 groups, 100 women in each group (Primis & 2^nd gravidas between 19–34 years of age) having hemoglobin above 10 gm% in cephalic presentation with almost identical indications for CS excluding prematurity, APH, IUGR, bleeding disorders, fibroids etc. Standard caesarean procedure followed except exteriorization of uterus before placenta delivery and IMM oxytocin 5 IU in Gr1; and intra-abdominal repair and slow IV 10 IU oxytocin in Gr2. Preoperative, Postoperative and difference of Hb, duration of surgery from baby birth to starting of abdominal closure, blood-loss by volumetric method noted and compared after mean calculation by student t and chi-square test. Intra-operative and post-operative complications compared by relative risk calculation.

The values of postoperative Hb level 99.2 against 89.2g/l, Hb difference between pre-and postoperative level 12.7 against 23.2g/l, blood loss 394.8 ml against 461.6 ml, duration of surgery 11 min 10 sec against 19 min 53 sec were highly significant (p < 0.0001 by student t and chi square test). The hospital stay with relative risk calculation shows significant difference between 2 groups.

Exteriorization of uterus before placental separation and IMM oxytocin reduces not only blood loss and time taken in caesarean sections, also the hospital stay.