Extra-abdominal Removal of Placenta During CS

NCT ID: NCT02101450

Last Updated: 2015-01-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-31

Study Completion Date

2014-12-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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the Influence of Intra- vs Extra-abdominal Removal of Placenta Duration of Operation the Amount of Aspirated Fluid During the Operation Difference Between Pre- and Post-operative CBC

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Intra-abdominal removal of the placenta

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.

Group Type NO_INTERVENTION

No interventions assigned to this group

Extra-abdominal removal of the placenta

No drug or device is used. 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 section will be completed as described in "No intervention" group.

Group Type EXPERIMENTAL

Extra-abdominal removal of the placenta

Intervention Type PROCEDURE

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

Extra-abdominal removal of the placenta

Intervention Type PROCEDURE

The placenta will be manually removed extra-abdominally, with uterine massage as soon as possible.

Extra-abdominal removal of the placenta

Intervention Type PROCEDURE

The cesarean incision will be sutured with no. 1 Vicryl ®.

Extra-abdominal removal of the placenta

Intervention Type PROCEDURE

Uterus will be replaced in the abdominal cavity.

Interventions

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Extra-abdominal removal of the placenta

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

Intervention Type PROCEDURE

Extra-abdominal removal of the placenta

The placenta will be manually removed extra-abdominally, with uterine massage as soon as possible.

Intervention Type PROCEDURE

Extra-abdominal removal of the placenta

The cesarean incision will be sutured with no. 1 Vicryl ®.

Intervention Type PROCEDURE

Extra-abdominal removal of the placenta

Uterus will be replaced in the abdominal cavity.

Intervention Type PROCEDURE

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Near East University, Turkey

OTHER

Sponsor Role lead

Responsible Party

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Baris KAYA

OBSTETRICS AND GYNECOLOGY CONSULTANT, MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Baris Kaya, MD

Role: PRINCIPAL_INVESTIGATOR

Near East University, Obstetrics and Gynecology, Lefkosa-TRNC, Mersin 10, Turkey

Locations

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Near East University, Obstetrics and Gynecology

Mersin, Trnc, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Other Identifiers

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KAYA-2013-1

Identifier Type: -

Identifier Source: org_study_id

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