A comparative study of exteriorization and intraperitoneal closure of uterus in caesarean delivery

Bharathi K. R., Mahendra G., Vindhyshree S., Sonia Sherawath


Background: Caesarean delivery is the most common intraperitoneal surgical procedure in obstetrics. Many surgical techniques for caesarean delivery have been described, and the debate about the ideal caesarean technique to minimize morbidity is going on still. The aim of this study was to assess the intraoperative and postoperative advantages and disadvantages following exteriorization of uterus at caesarean section with intraperitoneal repair of uterus.

Methods: It is a randomized controlled trial conducted at Adichunchanagiri Institute of Medical Sciences, B G Nagar, Mandya. Minimum of 100 cases, 50 each were randomly allocated into case and control groups. All patients who were undergoing emergency and elective caesarean delivery under spinal anaesthesia were randomly allocated into exteriorization and intraperitoneal group. In exteriorization group, uterus is exteriorized after delivery of foetus and placenta for repair, whereas in intraperitoneal group in situ repair was done. A pfannenstiel incision was taken for all the cases. Placenta was removed either by controlled traction after spontaneous separation or manually. Uterus was exteriorized after delivery of placenta and may be repaired by single or double layer. Visceral and parietal peritoneum are not closed.

Results: There is significant difference in the operating time in the exteriorization group and in the in-situ group. But no significant difference between 2 groups regarding nausea, vomiting intra operatively, in return of bowel function, number of analgesic doses, incidence of cystitis, endometritis and wound infection. Period of hospitalization were also same in both groups.

Conclusion: Exteriorization of uterus at caesarean delivery has the advantages less perioperative haemoglobin reduction, good exposure, good access to incision angle, especially during difficult extraction. Easy identification of uterine anomaly, adnexal mass if present and exposure of posterior aspect of lower segment.


Caesarean delivery, Exposure, Exteriorization, Intraperitoneal closure

Full Text:



Cunnigham FG, Gant NF, Leveno KJ, Gilstra III LC, Hauth JC, Westrom KD. Caesarean delivery and postpartum hysterectomy. Textbook of Williams Obstetrics, 23rd edition. New York; McGraw Hill; 2001:538-59.

Quilligan EJ, Wharton TJ. Cesarean section. Clin Obstet Gynecol. 1985;28(4):689-90.

Arulkumaran S, Ratnam SS. Caesarean deliveries changing trends. In: Rao KB, eds. The management of labour. Orient Longman; 2001:308.

Dutta DK, Dutta B. History of caesarean delivery. In: Textbook of caesarean delivery. A FOGSI Publications, New Delhi; Jaypee Brothers. 2016:1-3.

Kumar SAA. Exteriorization of uterus at caesarean section. J Obstet Gynecol India. 2003;53(4):353-8.

Mishra R. Caesarean section. Ian Donald Practical obstetric problem. 5th ed. BI publication Pvt. Ltd. New Delhi; 1998:827-38.

Arulkumaran S, Ratnam SS. Operative delivery. Donald MF Gibb. The management of labour. Orient Longman; 2001:137.

Hershey DW, Quilligan EJ. Extra abdominal uterine exteriorizationat caesarean section. Obstet Gynecol. 1978;52:189-92.

Wahab MA, Karantzis P, Eccerley PS, Russell IF, Thompson JW, Lindow SW. A randomized controlled study of uterine exteriorization and repair at caesarean section. Br J Obstet and Gynecol. 1999;106:913-6.

Sood AK. Exteriorization of uterus at Cesarean section. J Obstet Gynecol Ind. 2003;53(4):353-8.

Magann EF, Dodson MK, Allbert JR, McCurdy Jr CM, Martin RW, Morrison JC. Blood loss at the time of caesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision. Surg Gynecol Obstet. 1993;177:389-92.

Wilkinson C, Enkin MW. Uterine exteriorization versus intraperitoneal repair at caesarean section. Cochrane Database Syst Rev. 2000;2:CD000085.