Intra-abdominal irrigation at cesarean delivery: a randomized controlled trial

Abstract

Objective: To determine whether avoiding intra-abdominal irrigation at cesarean delivery will decrease rates of intraoperative and postoperative gastrointestinal disturbance without increasing postoperative morbidity.

Methods: This was a randomized controlled trial of patients undergoing cesarean delivery. Patients were randomized to irrigation after closure of the hysterotomy compared with no irrigation. The cesarean delivery was otherwise performed in the usual fashion. The patient was blinded to treatment once assigned. The primary outcome was maternal intraoperative nausea. The secondary outcomes were postoperative maternal gastrointestinal disturbance and incidence of maternal infectious morbidity.

Results: Two hundred thirty-six patients were randomized; 126 were randomized to no irrigation and 110 were randomized to irrigation. Both were similar with respect to age, body mass index, operative time, blood loss, uterine incision, tubal ligation, exteriorization of the uterus, packing of bowel, lysis of adhesions and bladder flap, and peritoneal or rectus muscle closure. Intraoperative nausea was significantly more frequent with irrigation compared with no irrigation (51 of 110 [46.4%] compared with 36 of 126 [28.26%]; relative risk 1.62, 95% confidence interval 1.15-2.28). We noted no statistically significant differences for intraoperative emesis, preoperative chorioamnionitis, postoperative nausea, postoperative emesis, postoperative antiemetic administration, endometritis, or postoperative febrile morbidity. There was an increased trend of postoperative nausea and antiemetic use with irrigation.

Conclusion: Irrigation at cesarean delivery increases intraoperative nausea without decreasing postoperative infectious morbidity.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01479712.

Level of evidence: I.