Cesarean section is one of the oldest surgical interventions in the history of medicine.Many variations in cesarean section technique have been studied.The investigatory team are aiming to decrease blood loss during cesarean section by vertical splitting versus transverse cutting of muscle layer in lower segment cesarean sections to avoid uterine vessels injury.
Cesarean section is one of the oldest surgical interventions in the history of medicine.Since the first documented cesarean delivery in 1020 AD, various modifications have been made in the technique. It was a surgery performed as a last resort, mostly peri- or post-portem. Many variations in cesarean section technique have been studied.our study aim is to decrease blood loss during cesarean section through decreasing incidence of uterine vessels injury. The investigator supposed that applying Vertical pull on a small C-shaped incision in the lower uterine segment during cesarean section allows the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
400
Transverse cutting and/or pulling.of lower uterine segment during lower cesarean section extending the uterine incision laterally.
vertical splitting of lower uterine segment during lower cesarean section making the direction of traction up and downward instead of being laterally and we suppose that this will allow the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery.
Ahmed Abass
Cairo, Egypt
Uterine vessels injury
the surgeon performing the cesarean section will detect if injury of uterine vessels occurred or not while extending uterine incision.
Time frame: 1 minute after extraction of the baby and placenta
uterine incision extension
the surgeon performing the cesarean section will detect if uterine incision extension occurred or not after extraction of the baby and the placenta.
Time frame: 2 minutes extraction of the baby and placenta
intra-operative blood loss
blood loss will be assessed by circulating nurse through counting soaked surgical towels and gauze and calculating estimated blood loss in vacation suction system.
Time frame: before closure of the abdominal wall layer
postpartum hemorrhage
will be defined by postpartum blood loss of 1000cc
Time frame: first 24 hours after delivery
postoperative pain
pain scale from 0 to 10 to assess postoperative pain after delivery
Time frame: 2 hours after delivery
postoperative pain
pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery
Time frame: 6 hours after delivery
postoperative pain
pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery
Time frame: 12 hours after delivery
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postoperative pain
pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery
Time frame: 24 hours after delivery