番茄社区

WASHINGTON -- When intrauterine cleansing was performed following cesarean section, there was no significant difference in adverse maternal events compared with patients who did not undergo intrauterine cleansing, researchers reported here.

In an intent-to-treat analysis, rates of endomyometritis, or sepsis involving tissues of the uterus, were nonsignificant between the cleansing group and the noncleansing group. However, a smaller portion of the cleansing group developed the infection (2.0% versus 2.9%, respectively, RR 0.60, 95% CI 0.60-1.42), reported , of Michigan State University-Sparrow Hospital in Lansing, and colleagues.

Examining secondary outcomes, the cleansing group had lower rates of postpartum hemorrhage (5.8% versus 7.7%, RR 0.75, 95% CI 0.6-1.2) and hospital readmission (2.9% versus 3.8%, RR 0.75, 95% CI 0.5-1.6). There was also no difference observed for mean surgical time, hospital length of stay, or time to return of gastrointestinal function, they said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

"The rationale behind intrauterine cleaning after placental delivery is that leaving behind membranes and clots can actually predispose patients to infection or bleeding," said Eke at the presentation. "However, these benefits remain uncertain."

To examine this issue, Eke's group conducted a prospective randomized controlled trial of 206 women undergoing elective C-section to receive either intrauterine cleaning or omission of cleaning. They determined that in order to detect a 20% difference, they needed 103 women per group. They only examined women at lower risk for infection, excluding patients with spontaneous rupture of membranes before C-section section, chorioamnionitis, poorly controlled diabetes mellitus, and immunosuppressive disorders.

There was no statistically significant difference in rates of need for repeat surgery or quantitative blood loss between the two groups.

Eke's group concluded that in women at lower risk for infection, this trial "provides evidence" that omission of intrauterine cleaning during C-section deliveries does not increase risk for infection. However, they called for larger studies to examine this issue.

, member of the ACOG committee, Practice Bulletins -- Obstetrics agreed. He told 番茄社区 that even though there was no statistically significant difference between the two groups, the study did not have enough power, and a bigger trial might provide more definitive results.

"We've been saying for years that [intrauterine cleaning] reduces the risk of infection, and [the findings] points in that direction that it probably does, but we can't say that conclusively in either direction," said Caughey, who was not involved in the study. "You wouldn't change your practice over these results. I'll make sure my residents keep cleaning out the uterus."

"If you were currently cleaning out the uterus with a lap sponge, it would be unfortunate if you read this paper and said 'Well I guess it makes no difference, I'll stop doing that,'" he added.