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Completed

NCT Number: NCT02101450

Extra-abdominal Removal of Placenta During CS

During cesarean section, it is important to provide hemostasis as well as to decrease the amount of hemorrhagic fluid and fibrin in the abdominal cavity. Hemorrhagic fluid and fibrin together may cause adhesion formation and therefore postoperative ileus, retardation in regaining the gastrointestinal functions as well as prolongation of the operation itself. Dragging the uterus out of the abdominal cavity during cesarean section before removing the placenta (extra-abdominal removal of the placenta) may decrease the amount of blood flowing into the abdominal cavity during removal of placenta. In this study the investigators aimed to evaluate the influence of intra abdominal vs extra abdominal removal of placenta on duration of operation, the amount of aspirated fluid during the operation, difference between postoperative hemoglobin and hematocrit levels, postoperative pain score, additional need of analgesia, postoperative bowel movements, postoperative endometritis and wound infection.

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Key information

Conditions

the Influence of Intra- vs Extra-abdominal Removal of Placenta Difference Between Pre- and Post-operative CBC Duration of Operation Hemorrhage Pathologic Processes Pathological Conditions, Signs and Symptoms the Amount of Aspirated Fluid During the Operation

Age range

18 year–50 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Near East University, Obstetrics and Gynecology

Mersin, Trnc, 10, Turkey (Türkiye)

About this study

In this study the investigators will recruit 200 pregnant women; 100 women in the study group and 100 women in the control group. The women will be randomly allocated in two groups. The odd numbered women will be in the study group and even numbered women will be in the control group.

The investigators will perform cesarean section according to the obstetrical indications. Lower segment uterine incision will be used during the cesarean section. After the delivery of the fetus two distinct procedures will be used in the control and study groups.

In the control group, the uterus will be left in the abdominal cavity and the placenta will be manually removed with uterine massage as soon as possible. After removal of the placenta, the uterus will be dragged out of the abdominal cavity. The cesarean incision will be sutured with no. 1 Vicryl ®. Uterus will be replaced in the abdominal cavity. Intra-abdominal cavity will be cleaned by aspirator and mounted-gauze tampon. The weight of the placenta will be measured. The weight of the gauze tampons will be measured with gravimetric method before and after use.

In the study group, at first, the uterus will be dragged out of the abdominal cavity, prior to removal of the placenta. The placenta will be manually removed with uterine massage as soon as possible. The cesarean incision will be sutured with no. 1 Vicryl ®. Uterus will be replaced in the abdominal cavity. Intra-abdominal cavity will be cleaned by aspirator and mounted-gauze tampon. The weight of the placenta will be measured. The weight of the gauze tampons will be measured with gravimetric method before and after use.

In both groups, the abdominal cavity will be closed as appropriate. The vital signs (blood pressure and heart rate) will be monitored. Postoperative blood samples for complete blood count (CBC) will be taken 24 hours after the operation. Bowel movements will be assessed every 6 hours by a stethoscope. Time of the first flatulence will be recorded. Visual Analog Scoring (VAS) survey validated in Turkey will be performed in the postoperative 1. and 2. days. The type and amount of postoperative analgesics will be recorded. The body temperature will regularly be assessed in the first 24. and 48. hours. The presence of fever will be recorded.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Women undergoing cesarean section according to the obstetrical indications.

Exclusion criteria

  • Uterine anomalies such as didelphys, bicornis, etc.
  • Placental adhesion anomalies
  • Postpartum uterine hemorrhage (>500 ml)
  • Polyhydramnios
  • Uterine atony
  • Women with known coagulation disorders
  • Abnormal preoperative APTT, PT and INR

Treatment and study plan

Extra-abdominal removal of the placenta

Procedure

The uterus will be dragged out of the abdominal cavity, prior to removal of the placenta.

Primary outcomes

  1. The amount of aspirated fluid during the cesarean section

    Time frame: 3 months

    The amount of aspirated fluid during the cesarean section in mililiters

Secondary outcomes

  1. Difference between preoperative and postoperative hemoglobin levels

    Time frame: 3 months

    Difference between preoperative and postoperative hemoglobin levels expressed as g/dL

  2. The weight of the gauze before and after use in cesarean section

    Time frame: 3 months

    The weight of the gauze before and after use in cesarean section, described in miligrams

Sponsors and collaborators

Lead sponsor

Near East University, Turkey

Other

Registry information

Official study title

Evaluation of the Effects of Extra-abdominal Removal of the Placenta During Cesarean Section on the Amount of Bleeding Into the Abdominal Cavity.

Important dates

Study start
2014
Primary completion
2014
Study completion
2014
First posted
Apr 2, 2014
Registry last updated
Jan 13, 2015

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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