Comparison between Intra-abdominal and Extra-abdominal Repair of the Uterus with Relation to Intraoperative Haemodynamic Changes in Patients Undergoing LSCS under Spinal Anaesthesia: A Cohort Study

Exteriorisation of the uterus during caesarean section offers the benefit of faster repair of uterine incision, reduced blood loss and shorter Duration of Surgery (DOS). However, this technique has been associated with haemodynamic disturbances in the intraoperative period particularly while repositioning the uterus into the abdominal cavit y af ter repairing it. This could prove detrimental for the patient, if not corrected promptly. Aim: To assess whether exteriorisation of the uterus for the repair of uterine incision has an effect on the haemodynamic changes and comparing the same with the intra-abdominal repair technique of uterine incision. Materials and Methods: ASA I and II pregnant females undergoing elective/emergency caesarean section under spinal anaesthesia for various obstetric indications were enrolled in this cohort study. The duration of study was 6 months after getting approval from IEC (September 2019 to February 2020). As per the discretion of the operating surgeon, the uterus of the patients undergoing caesarean section was repaired either intra-abdominally (Group I) or after exteriorisation of the uterus (Group E) and the patients were grouped accordingly. Haemodynamic monitoring was done every 5 minutes after giving spinal anaesthesia until the completion of the caesarean section using a standard automated multi-parameter monitor. Data was recorded and the two groups were compared with regard to the haemodynamic changes during intraoperative period, DOS, the incidence of any adverse events namely nausea and vomiting and Time To First Rescue Analgesia (TTFRA) in the postoperative period. Unpaired t-test was used to compare and analyse the data between the two groups, where ever applicable. A p-value of less than 0.05 was considered statistically significant. Chi-square test was used for qualitative data analysis. Results: Analysis of data between the two groups showed a significant fall in Systolic and Diastolic Blood Pressure (SBP and DBP) in Group E compared to Group I at 10 minutes [p=0.046 (SBP) and p=0.039 (DBP)], 30 minutes [p=0.047 (SBP) and p=0.002 (DBP)] and 35 minutes [p=0.046 (SBP) and p=0.006 (DBP)] time interval after giving spinal anaesthesia which was attributed to uterine exteriorisation to repair the uterine incision in Group E. The incidence of nausea, hypotension and pelvic discomfort was also significantly higher in Group E compared to Group I. Owing to less uterine handling, patients in Group I secured analgesia for a significantly longer time (TTFRA=244 min) in the postoperative period compared to patients in Group E (TTFRA=217 min) (p≤0.001). Conclusion: Extra-abdominal repair of the uterine incision carries the risk of haemodynamic disturbances associated with nausea and vomiting.