Intraperitoneal Saline Irrigation in Cesarean Section

Cesarean section is one of the most commonly performed surgical procedures worldwide. Despite advances in surgical techniques, aseptic measures, and perioperative antibiotic prophylaxis, postoperative complications such as infectious morbidity and paralytic ileus remain significant causes of maternal morbidity, prolonged hospital stay, and increased healthcare costs. Postoperative infectious morbidity may include endometritis, wound infection, pelvic abscess, and febrile morbidity, while paralytic ileus may delay recovery, ambulation, and initiation of oral feeding.

Intraperitoneal saline irrigation has been proposed as a simple and inexpensive intraoperative technique that may reduce postoperative complications. Irrigation may help remove blood clots, tissue debris, vernix caseosa, and bacterial contaminants from the peritoneal cavity, thereby decreasing inflammatory response and the risk of postoperative infection. In addition, reducing intra-abdominal irritation may improve bowel motility and decrease the incidence of postoperative paralytic ileus.

However, the effectiveness of intraperitoneal saline irrigation during cesarean section remains controversial. Some studies have suggested potential benefits in reducing postoperative febrile morbidity and improving recovery, while others reported no significant advantage. Due to the limited and conflicting evidence, further randomized controlled studies are needed to evaluate the role of intraperitoneal saline irrigation in cesarean delivery.

Therefore, this study aims to assess the effect of intraperitoneal saline irrigation in cesarean section on postoperative infectious morbidity and paralytic ileus.

Inclusion criteria

• Age 18-40 years
• Elective CS at term ≥37 weeks
• Singleton pregnancy
• Intact membranes
• BMI 18.5 - 34.9 kg/m²

Exclusion criteria

• Chorioamnionitis or intrauterine infection
• Prolonged rupture of membranes > 18 hours
• History of previous abdominal surgery other than CS
• Immunocompromised patients or on corticosteroids
• Severe anemia Hb < 8 g/dL
• Diabetes mellitus or hypertension
• Placenta previa or accreta spectrum disorders
• Emergency CS for uterine rupture or severe bleeding
• Known allergy to normal saline