Comparison of Exteriorized With In-Situ Uterine Repair in Caesarean Section Under Spinal Anaesthesia: A Prospective Observational Study

Comparison of Exteriorized With In-Situ Uterine Repair in Caesarean Section Under Spinal Anaesthesia: A Prospective Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Exteriorized With In-Situ Uterine Repair in Caesarean Section Under Spinal Anaesthesia: A Prospective Observational Study Ayaz Farooqi¹, dr Burjees, Misbah Jabeen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6839397/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Cesarean section is one of the most frequently performed obstetric procedures worldwide. Different surgical techniques have been explored to optimize patient outcomes, among which the method of uterine repair—exteriorized versus in-situ—remains debated. This study compares the effects of exteriorized versus in-situ uterine repair on postoperative nausea, vomiting, pain, patient discomfort, and hemodynamic variables. Methods A total of 60 parturients scheduled for elective cesarean under spinal anesthesia were randomly assigned to two groups: Group A (exteriorized uterine repair) and Group B (in-situ uterine repair). Various intraoperative and postoperative parameters were recorded, including nausea, vomiting, pain (VAS scale), patient discomfort, and requirements of rescue analgesics and antiemetics at designated intervals. Results Exteriorized uterine repair was associated with higher incidences of intraoperative nausea and vomiting, greater postoperative pain, higher need for rescue analgesics and antiemetics, and increased heart rate variability, suggesting significant patient discomfort. In contrast, in-situ uterine repair demonstrated better patient tolerance with lower pain scores and reduced nausea-vomiting episodes. Conclusion This study suggests that in-situ uterine repair is preferable, providing better patient comfort and lower postoperative morbidity. Given the adverse effects observed with exteriorized uterine repair, in-situ repair should be prioritized whenever feasible. Introduction Cesarean section (CS) is a life-saving obstetric procedure performed globally, yet it carries higher maternal morbidity compared to vaginal delivery. 1 Techniques optimizing operative time, patient comfort, and postoperative recovery are crucial. 2 Among several debated refinements in CS, the method of uterine repair post-delivery remains controversial. Traditionally, two approaches are utilized: In-situ uterine repair (the uterus remains inside the abdominal cavity). 3 Exteriorized uterine repair (the uterus is temporarily delivered outside for improved visualization during suturing). 4 Although exteriorized repair has been advocated for better surgical exposure 5 , ease of repair, and reduced hemorrhage 6 , its drawbacks include: Increased intraoperative and postoperative pain Higher incidence of nausea and vomiting 7 Greater patient discomfort Potential risks such as venous air embolism and utero-ovarian trauma 8 Previous studies have shown conflicting findings, necessitating further research. 9 This study aims to analyze and compare patient outcomes between exteriorized and in-situ uterine repair in cesarean sections performed under spinal anesthesia. 10 Materials and Methods Study Design This prospective observational study was conducted in the Department of Anesthesia and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J&K, INDIA between June 2018 and June 2020. Study Population A total of 60 patients (ASA Grade II & III) undergoing elective CS at term were included. Patients were randomly allocated into two groups: Group A (Exteriorized Uterine Repair, n = 30) Group B (In-situ Uterine Repair, n = 30) Patients with previous abdominal surgery, placenta previa, placenta accreta, placenta percreta, multiple pregnancies, or complicated pregnancies were excluded. Procedure Spinal anesthesia was administered using 0.5% hyperbaric bupivacaine + fentanyl. Hemodynamic parameters were continuously monitored. Patients were evaluated for: Nausea/Vomiting (3-point scale) Pain (VAS scale: 0–10) Discomfort Requirement of rescue analgesics and antiemetics at designated intervals (intraoperatively, 2, 4, 6, and 12 hours postoperatively). Statistical Analysis Data were analyzed using SPSS software. Variables were compared using appropriate statistical tests, with significance set at p 0.05). Hemodynamic Changes Heart rate was significantly higher in the exteriorized group during uterine closure and at various postoperative intervals (p < 0.001). Blood pressure showed no significant difference. Intraoperative Nausea and Vomiting Significantly higher incidence of nausea and vomiting in the exteriorized group (p = 0.001). Pain and Discomfort VAS scores were significantly higher in the exteriorized repair group. In-situ repair resulted in better comfort and lower pain scores. Requirement of Rescue Analgesics and Antiemetics Exteriorized repair required significantly more rescue antiemetics and analgesics compared to in-situ repair (p < 0.001). Duration of Surgery Exteriorized repair showed shorter operative time, but the difference was statistically insignificant (p = 0.009). Discussion This study highlights that in-situ uterine repair is more advantageous than exteriorized repair in cesarean sections under spinal anesthesia. 11 As shown in Table 1. While exteriorized repair may provide better surgical exposure, its drawbacks—higher pain scores, increased patient discomfort, greater nausea and vomiting, and higher rescue medication requirements—outweigh its benefits. 12 These findings align with previous research (Magann et al., 1993; Siddiqui et al., 2007; Mireault et al., 2020), 7 which reported higher morbidity associated with exteriorization. Given these observations, in-situ repair should be preferred whenever possible to enhance patient comfort and recovery. 14, 15 Conclusion This study demonstrated that exteriorized uterine repair leads to greater patient discomfort, increased nausea and vomiting, and higher analgesic/antiemetic requirements compared to in-situ repair. As patient well-being remains paramount, routine exteriorization of the uterus should be discouraged in cesarean sections performed under spinal anesthesia. (Table 1 ) Declarations Human Ethics and Consent to Participate This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and adhered to the guidelines set by the Institutional Ethics Committee of Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J&K, INDIA. Approval was obtained prior to participant recruitment, ensuring compliance with all regulatory and ethical standards. All eligible participants were thoroughly informed about the study’s objectives, methodology, potential risks, and benefits. Written informed consent was obtained from each participant before enrollment, affirming their voluntary participation and understanding of their rights, including the option to withdraw at any stage without consequences. Confidentiality was strictly maintained, and all data handling followed institutional and regulatory protocols. Consent to Participate All participants in this study provided informed consent before enrollment. They were thoroughly briefed on the study's purpose, procedures, potential risks, and benefits. Each participant signed a written consent form, affirming their voluntary participation and understanding of their rights, including the option to withdraw at any stage without consequences. Confidentiality was ensured, and all personal data were handled in accordance with ethical guidelines and institutional regulations. Name of the Institutional Ethics Committee Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J&K, INDIA. Funding Declaration This study was conducted without any external funding. The authors declare that no financial support was received from any funding agency, commercial entity, or non-profit organization. All research-related expenses were managed independently by the research team. Clinical Trial Registration: Not Required This study is a prospective observational study conducted in the Department of Anesthesia and Critical Care at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J&K, India, between June 2018 and June 2020. As an observational study, formal clinical trial registration was not required. However, ethical approvals were obtained in accordance with institutional and regulatory guidelines. Author Contribution Author ContributionsM.A. (Dr. Misbah Jabeen): Responsible for data collection, patient follow-ups, statistical analysis, and manuscript drafting. Also contributed significantly to literature review and interpretation of findings.A.F. (Professor Dr. Ayaz Farooqi): Conceptualized the study design, supervised methodology, reviewed manuscript drafts, and provided critical input for clinical relevance. Ensured ethical approvals and guided the overall research framework.D.B. (Dr. Burjees): Assisted in patient selection, intraoperative data collection, and result tabulation. Also contributed to manuscript editing and final revisions for journal submission. References Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: New data from the birth certificate, 2013. Natl Vital Stat Rep. 2015;64:1–13. Incerpi MH, Decherney AH, Nathan L, Laufer N, Roman A. Diagnosis and Treatment, Obstetrics and Gynecology. McGraw-Hill, 2013; 334 – 48. Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto VA. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med. 2007;20:53–7. Birnbach DJ, Browne IM. Anesthesia for Obstetrics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, Eds. Miller's Anesthesia , 7th Edition, Churchill Livingstone, 2009; 2203–2210. Tsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, editor. Obstetric anesthesia principles and practice. Elsevier Inc.; 2009. p. 521. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103:645–53. Siddiqui M, Goldszmidt E, Fallah S, Windrim R, Carvalho JC. Complications of exteriorized compared with in situ uterine repair at cesarean delivery under spinal anesthesia: a randomized controlled trial. Obstet Gynecol. 2007;110:570–5. Jacobs-Jokhan D, Homey GJ. Extra-abdominal versus Intra-abdominal repair of the uterine incision at cesarean section. Cochrane Database Syst Rev. 2004;4:CD000085. Lowenwirt IP, Chi DS, Handwerker SM. Nonfatal venous air embolism during cesarean section: a case report and review of the literature. Obstet Gynecol Surv. 1994;49:72–6. Chauhan S. A randomized comparative study of exteriorization of uterus versus in situ intra-peritoneal repair at cesarean delivery. Int J Reprod Contracept Obstet Gynecol. 2017;7:281–6. Young JH. The History of Caesarean Section. HK Lewis & Co; 1944. Phaneuf LE. Caesarean section followed by temporary exteriorization of uterus: Portes operation. Surg Gynecol Obstet. 1927;44:788–94. Hershey DW, Quilligan EJ. Extraabdominal uterine exteriorization at cesarean section. Obstet Gynecol. 1978;52:189–92. Magann EF, Dodson MK, Allbert JR, McCurdy CM, Martin RW, Morrison JC. Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision. Surg Gynecol Obstet. 1993;177:389–92. Wahab MA, Karantzis P, Eccersley PS, Russell IF, Thompson JW, Lindow SW. A randomized, controlled study of uterine exteriorization and repair at cesarean section. Br J Obstet Gynaecol. Tables Table 1: Comparison of Key Findings Between Exteriorized vs. In-Situ Uterine Repair in Cesarean Section Variable Exteriorized Uterine Repair (Group A) In-Situ Uterine Repair (Group B) P-Value Mean Age (years) 29.7 ± 3.175 30.23 ± 1.96 >0.05 (NS) Mean Duration of Surgery (minutes) 43.3 ± 3.5 44.1 ± 3.6 0.009 (NS) Heart Rate (bpm) During Uterine Closure 81.9 ± 4.1 66.3 ± 5.1 <0.05 (S) Heart Rate (bpm) at End of Surgery 82.9 ± 4.0 72.3 ± 4.6 <0.01 (S) Heart Rate (bpm) at 2 hrs Post Surgery 104.6 ± 5.2 86.3 ± 3.9 <0.01 (S) Heart Rate (bpm) at 12 hrs Post Surgery 99.7 ± 6.2 81.4 ± 5.3 <0.01 (S) Incidence of Nausea During Uterine Closure (%) 38.7% 24% 0.001 (S) Incidence of Vomiting at 2 hrs Post Surgery (%) 21% 12.6% 0.003 (S) VAS Pain Score During Uterine Closure 6.13 ± 1.34 2.65 ± 0.77 <0.05 (S) VAS Pain Score at End of Surgery 5.15 ± 1.18 1.85 ± 0.77 <0.05 (S) VAS Pain Score at 12 hrs Post Surgery 4.23 ± 0.66 0.08 ± 0.02 <0.05 (S) Need for Rescue Analgesics (%) Higher Requirement Lower Requirement <0.001 (S) Need for Rescue Antiemetics (%) Higher Requirement Lower Requirement <0.001 (S) Legend: NS = Not Significant S = Statistically Significant This table summarizes all key comparisons between the two techniques, clearly illustrating that exteriorized repair leads to greater pain, nausea, vomiting, and higher medication requirements compared to in-situ uterine repair . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviewers invited by journal 15 Jul, 2025 Editor invited by journal 23 Jun, 2025 Editor assigned by journal 19 Jun, 2025 Submission checks completed at journal 19 Jun, 2025 First submitted to journal 06 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6839397","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486019961,"identity":"de836daa-5a01-4776-877a-7e728c693515","order_by":0,"name":"Ayaz Farooqi¹","email":"","orcid":"","institution":"Sher-i-Kashmir Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ayaz","middleName":"","lastName":"Farooqi¹","suffix":""},{"id":486019963,"identity":"571182a6-3ec3-46e9-b4fd-05cf72d1a3a9","order_by":1,"name":"dr Burjees","email":"","orcid":"","institution":"Sher-i-Kashmir Institute of Medical Sciences","correspondingAuthor":false,"prefix":"dr","firstName":"","middleName":"","lastName":"Burjees","suffix":""},{"id":486019964,"identity":"0270000b-1ef1-4433-9e67-931ed8b96126","order_by":2,"name":"Misbah Jabeen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYHACxgcJFf+ANPMBICEhQ4wWZoMPZ0Cq2RJAWniI0cImObMNpIXHAMQjrMWc/ewDaR62O/K67Wc+v7pRY8HDwH746AZ8Wix70g2MeXieGW47k7vNOucY0GE8aWk38GkxOJDGkMwjwcy47QbvNuMcNqAWCR4z/FrOP2M4zGPAbL/tBs8z45x/xGi5kcbYOCPhcCJQC/Pj3DYitFjOeMbM8OFAWvK2M2lmzLl9EjxshPxizp/G/iPxn43ttuOHH3/O+VYnx89++Bh+hyGx2STAJD7l6FqYPxBSPQpGwSgYBSMTAAAgjUpi1BXaTgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Kashmir","correspondingAuthor":true,"prefix":"","firstName":"Misbah","middleName":"","lastName":"Jabeen","suffix":""}],"badges":[],"createdAt":"2025-06-06 20:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6839397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6839397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86976355,"identity":"89c0a5cf-4355-4e72-934c-bc1a5f40ee5a","added_by":"auto","created_at":"2025-07-17 21:39:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824705,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6839397/v1/d0ca173b-b607-4ea4-aa21-4bebbcf58403.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparison of Exteriorized With In-Situ Uterine Repair in Caesarean Section Under Spinal Anaesthesia: A Prospective Observational Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCesarean section (CS) is a life-saving obstetric procedure performed globally, yet it carries higher maternal morbidity compared to vaginal delivery.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Techniques optimizing operative time, patient comfort, and postoperative recovery are crucial.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAmong several debated refinements in CS, the method of uterine repair post-delivery remains controversial. Traditionally, two approaches are utilized:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn-situ uterine repair (the uterus remains inside the abdominal cavity).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eExteriorized uterine repair (the uterus is temporarily delivered outside for improved visualization during suturing).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eAlthough exteriorized repair has been advocated for better surgical exposure\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, ease of repair, and reduced hemorrhage\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, its drawbacks include:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIncreased intraoperative and postoperative pain\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHigher incidence of nausea and vomiting\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGreater patient discomfort\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePotential risks such as venous air embolism and utero-ovarian trauma\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePrevious studies have shown conflicting findings, necessitating further research.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This study aims to analyze and compare patient outcomes between exteriorized and in-situ uterine repair in cesarean sections performed under spinal anesthesia.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis prospective observational study was conducted in the Department of Anesthesia and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J\u0026amp;K, INDIA between June 2018 and June 2020.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eA total of 60 patients (ASA Grade II \u0026amp; III) undergoing elective CS at term were included. Patients were randomly allocated into two groups:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGroup A\u003c/b\u003e (Exteriorized Uterine Repair, n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGroup B\u003c/b\u003e (In-situ Uterine Repair, n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePatients with previous abdominal surgery, placenta previa, placenta accreta, placenta percreta, multiple pregnancies, or complicated pregnancies were excluded.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSpinal anesthesia was administered using 0.5% hyperbaric bupivacaine\u0026thinsp;+\u0026thinsp;fentanyl.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHemodynamic parameters were continuously monitored.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatients were evaluated for:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNausea/Vomiting (3-point scale)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePain (VAS scale: 0\u0026ndash;10)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDiscomfort\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRequirement of rescue analgesics and antiemetics at designated intervals (intraoperatively, 2, 4, 6, and 12 hours postoperatively).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS software. Variables were compared using appropriate statistical tests, with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDemographics\u003c/h2\u003e\u003cp\u003eThere was no significant difference in age between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHemodynamic Changes\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHeart rate was significantly higher in the exteriorized group during uterine closure and at various postoperative intervals (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBlood pressure showed no significant difference.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eIntraoperative Nausea and Vomiting\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSignificantly higher incidence of nausea and vomiting in the exteriorized group (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePain and Discomfort\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eVAS scores were significantly higher in the exteriorized repair group.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn-situ repair resulted in better comfort and lower pain scores.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eRequirement of Rescue Analgesics and Antiemetics\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExteriorized repair required significantly more rescue antiemetics and analgesics compared to in-situ repair (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDuration of Surgery\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExteriorized repair showed shorter operative time, but the difference was statistically insignificant (p\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights that in-situ uterine repair is more advantageous than exteriorized repair in cesarean sections under spinal anesthesia.\u003csup\u003e11\u003c/sup\u003eAs shown in Table 1.\u003c/p\u003e\n\u003cp\u003eWhile exteriorized repair may provide better surgical exposure, its drawbacks\u0026mdash;higher pain scores, increased patient discomfort, greater nausea and vomiting, and higher rescue medication requirements\u0026mdash;outweigh its benefits.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThese findings align with previous research (Magann et al., 1993; Siddiqui et al., 2007; Mireault et al., 2020),\u003csup\u003e7\u003c/sup\u003e which reported higher morbidity associated with exteriorization.\u003c/p\u003e\n\u003cp\u003eGiven these observations, in-situ repair should be preferred whenever possible to enhance patient comfort and recovery.\u003csup\u003e14, 15\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that exteriorized uterine repair leads to greater patient discomfort, increased nausea and vomiting, and higher analgesic/antiemetic requirements compared to in-situ repair.\u003c/p\u003e\u003cp\u003eAs patient well-being remains paramount, routine exteriorization of the uterus should be discouraged in cesarean sections performed under spinal anesthesia. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the \u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e and adhered to the guidelines set by the \u003cstrong\u003eInstitutional Ethics Committee\u003c/strong\u003e of Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J\u0026amp;K, INDIA. Approval was obtained prior to participant recruitment, ensuring compliance with all regulatory and ethical standards. All eligible participants were thoroughly informed about the study\u0026rsquo;s objectives, methodology, potential risks, and benefits. Written informed consent was obtained from each participant before enrollment, affirming their voluntary participation and understanding of their rights, including the option to withdraw at any stage without consequences. Confidentiality was strictly maintained, and all data handling followed institutional and regulatory protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in this study provided informed consent before enrollment. They were thoroughly briefed on the study\u0026apos;s purpose, procedures, potential risks, and benefits. Each participant signed a written consent form, affirming their voluntary participation and understanding of their rights, including the option to withdraw at any stage without consequences. Confidentiality was ensured, and all personal data were handled in accordance with ethical guidelines and institutional regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eName of the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eInstitutional Ethics Committee\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J\u0026amp;K, INDIA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted without any external funding. The authors declare that no financial support was received from any funding agency, commercial entity, or non-profit organization. All research-related expenses were managed independently by the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration: Not Required\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a prospective observational study conducted in the Department of Anesthesia and Critical Care at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, J\u0026amp;K, India, between June 2018 and June 2020. As an observational study, formal clinical trial registration was not required. However, ethical approvals were obtained in accordance with institutional and regulatory guidelines.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor ContributionsM.A. (Dr. Misbah Jabeen): Responsible for data collection, patient follow-ups, statistical analysis, and manuscript drafting. Also contributed significantly to literature review and interpretation of findings.A.F. (Professor Dr. Ayaz Farooqi): Conceptualized the study design, supervised methodology, reviewed manuscript drafts, and provided critical input for clinical relevance. Ensured ethical approvals and guided the overall research framework.D.B. (Dr. Burjees): Assisted in patient selection, intraoperative data collection, and result tabulation. Also contributed to manuscript editing and final revisions for journal submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCurtin SC, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: New data from the birth certificate, 2013. Natl Vital Stat Rep. 2015;64:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIncerpi MH, Decherney AH, Nathan L, Laufer N, Roman A. Diagnosis and Treatment, Obstetrics and Gynecology. McGraw-Hill, 2013; 334\u0026thinsp;\u0026ndash;\u0026thinsp;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGori F, Pasqualucci A, Corradetti F, Milli M, Peduto VA. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med. 2007;20:53\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBirnbach DJ, Browne IM. Anesthesia for Obstetrics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, Eds. \u003cem\u003eMiller's Anesthesia\u003c/em\u003e, 7th Edition, Churchill Livingstone, 2009; 2203\u0026ndash;2210.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, editor. Obstetric anesthesia principles and practice. Elsevier Inc.; 2009. p. 521.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103:645\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiddiqui M, Goldszmidt E, Fallah S, Windrim R, Carvalho JC. Complications of exteriorized compared with in situ uterine repair at cesarean delivery under spinal anesthesia: a randomized controlled trial. Obstet Gynecol. 2007;110:570\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJacobs-Jokhan D, Homey GJ. Extra-abdominal versus Intra-abdominal repair of the uterine incision at cesarean section. Cochrane Database Syst Rev. 2004;4:CD000085.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLowenwirt IP, Chi DS, Handwerker SM. Nonfatal venous air embolism during cesarean section: a case report and review of the literature. Obstet Gynecol Surv. 1994;49:72\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChauhan S. A randomized comparative study of exteriorization of uterus versus in situ intra-peritoneal repair at cesarean delivery. Int J Reprod Contracept Obstet Gynecol. 2017;7:281\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoung JH. The History of Caesarean Section. HK Lewis \u0026amp; Co; 1944.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhaneuf LE. Caesarean section followed by temporary exteriorization of uterus: Portes operation. Surg Gynecol Obstet. 1927;44:788\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHershey DW, Quilligan EJ. Extraabdominal uterine exteriorization at cesarean section. Obstet Gynecol. 1978;52:189\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagann EF, Dodson MK, Allbert JR, McCurdy CM, Martin RW, Morrison JC. Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision. Surg Gynecol Obstet. 1993;177:389\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWahab MA, Karantzis P, Eccersley PS, Russell IF, Thompson JW, Lindow SW. A randomized, controlled study of uterine exteriorization and repair at cesarean section. Br J Obstet Gynaecol.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Comparison of Key Findings Between Exteriorized vs. In-Situ Uterine Repair in Cesarean Section\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExteriorized Uterine Repair (Group A)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIn-Situ Uterine Repair (Group B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean Age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.7 \u0026plusmn; 3.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.23 \u0026plusmn; 1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;0.05 (NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean Duration of Surgery (minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43.3 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.1 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.009 (NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Rate (bpm) During Uterine Closure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.9 \u0026plusmn; 4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.3 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.05 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Rate (bpm) at End of Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.9 \u0026plusmn; 4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.3 \u0026plusmn; 4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Rate (bpm) at 2 hrs Post Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104.6 \u0026plusmn; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86.3 \u0026plusmn; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Rate (bpm) at 12 hrs Post Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99.7 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.4 \u0026plusmn; 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence of Nausea During Uterine Closure (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence of Vomiting at 2 hrs Post Surgery (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.003 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVAS Pain Score During Uterine Closure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.13 \u0026plusmn; 1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.65 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.05 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVAS Pain Score at End of Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.15 \u0026plusmn; 1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.85 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.05 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVAS Pain Score at 12 hrs Post Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.23 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.08 \u0026plusmn; 0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.05 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNeed for Rescue Analgesics (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher Requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower Requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNeed for Rescue Antiemetics (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher Requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower Requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e\u003c/p\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eNS\u003c/strong\u003e = Not Significant\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eS\u003c/strong\u003e = Statistically Significant\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThis table \u003cstrong\u003esummarizes all key comparisons\u003c/strong\u003e between the two techniques, clearly illustrating that \u003cstrong\u003eexteriorized repair leads to greater pain, nausea, vomiting, and higher medication requirements\u003c/strong\u003e compared to \u003cstrong\u003ein-situ uterine repair\u003c/strong\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6839397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6839397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCesarean section is one of the most frequently performed obstetric procedures worldwide. Different surgical techniques have been explored to optimize patient outcomes, among which the method of uterine repair\u0026mdash;exteriorized versus in-situ\u0026mdash;remains debated. This study compares the effects of exteriorized versus in-situ uterine repair on postoperative nausea, vomiting, pain, patient discomfort, and hemodynamic variables.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 60 parturients scheduled for elective cesarean under spinal anesthesia were randomly assigned to two groups: Group A (exteriorized uterine repair) and Group B (in-situ uterine repair). Various intraoperative and postoperative parameters were recorded, including nausea, vomiting, pain (VAS scale), patient discomfort, and requirements of rescue analgesics and antiemetics at designated intervals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eExteriorized uterine repair was associated with higher incidences of intraoperative nausea and vomiting, greater postoperative pain, higher need for rescue analgesics and antiemetics, and increased heart rate variability, suggesting significant patient discomfort. In contrast, in-situ uterine repair demonstrated better patient tolerance with lower pain scores and reduced nausea-vomiting episodes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study suggests that in-situ uterine repair is preferable, providing better patient comfort and lower postoperative morbidity. Given the adverse effects observed with exteriorized uterine repair, in-situ repair should be prioritized whenever feasible.\u003c/p\u003e","manuscriptTitle":"Comparison of Exteriorized With In-Situ Uterine Repair in Caesarean Section Under Spinal Anaesthesia: A Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 21:23:40","doi":"10.21203/rs.3.rs-6839397/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-16T01:18:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48401789910065349687985067642923296043","date":"2025-07-15T23:15:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T12:24:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T14:01:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T09:37:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T09:35:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-06-06T20:14:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e08efc0b-70ec-4ba3-9fcd-65a3e7d6d30f","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T21:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 21:23:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6839397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6839397","identity":"rs-6839397","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}