A Novel Technique Of Uterine Cooling During Repeated Cesarean Section For Reducing Blood Loss
Condition: Cesarean Section Complications; Intrapartum Hemorrhage; Postpartum Hemorrhage; Atony, Uterine
MeSH terms: Postpartum Hemorrhage; Uterine Inertia; Hemorrhage
Study type: Interventional

Summary: 
      Study aim to evaluate the efficacy and safety of a novel technique of UTERINE COOLING during
      repeated cesarean section (CS) in reducing blood loss, and record any adverse effects
      following it.
    

Detailed description: 
      Bleeding during vaginal or operative delivery is always of prime concern. Despite significant
      progress in obstetric care 125,000 women die from obstetric hemorrhage annually in the world.

      The incidence of caesarean delivery is increasing, and the average blood loss during
      caesarean delivery (1000 mL) is double the amount lost during vaginal delivery (500 mL).

      Caesarean section (CS) rate as high as 25-30% in many areas of the world. In Egypt the CS
      rate is 27.6 %, in United States of America, from 1970-2009 the CS rate rose from 4.5-32.9%,
      and declined to 32.8% of all deliveries at 2010. In spite of the various measures to prevent
      blood loss during and after caesarean section, post-partum hemorrhage (PPH) continues to be
      the most common complication seen in almost 20% of the cases, and causes approximately 25% of
      maternal deaths worldwide, leading to increased maternal morbidity and mortality. Indeed we
      need to reduce the bleeding during and after caesarean sections aiming for reducing the
      morbidity and mortality rate due to obstetric hemorrhage, which can be life threatening.

      The hematocrit level falls by 10% and blood transfusion is required in 6% of women undergoing
      caesarean delivery versus 4% of women who have a vaginal birth. Numerous methods for
      performing caesarean section exist targeting a safe delivery for the infant with minimum
      maternal morbidity. Operative morbidity includes hemorrhage, anemia, and blood products
      transfusion may be required associated with many risks and complications.

      Women who undergo a caesarean delivery are much more likely to be delivered by a repeat
      operation in subsequent pregnancies. For women undergoing subsequent cesarean, the maternal
      risks are even greater like massive obstetric hemorrhage, hysterectomy, admission to an
      intensive care unit, or maternal death. Medications, such as oxytocin, misoprostol and
      prostaglandin F2α, have been used to control bleeding postoperatively.

      The uterus is a smooth muscle whose contraction is modulated most directly by intrinsic or
      extrinsic oxytocin. During pregnancy the spiral arteries within the uterus and beneath the
      placenta enlarge to provide adequate perfusion to the placenta. After separation of the
      placenta the uterine smooth muscle cells contract in a pincer-like action to pinch the spiral
      arteries closed. When uterine contraction is inadequate (approximately 4-6% of normal
      pregnancies) the spiral arteries continue to bleed. If not addressed the bleeding can be
      excessive, even leading to maternal death. Approximately 5-8 out of 1,000 cesarean sections
      require hysterectomy to control bleeding.

      Release of calcium ions from sarcoplasmic reticulum stores is the immediateinitiator of
      contraction, and calcium's diffusion from the muscle filaments andre-uptake by the
      sarcoplasmic reticulum results in relaxation of contraction. Insome smooth muscles cold
      enhances contraction; perhaps by slowing the re-uptake of calcium.
    

Intervention name(s): Uterine Cooling Technique
Intervention type(s): Procedure
Intervention description(s): Standard LSCS will be done except immediatelyfollowing delivery of the fetus the uterus will beexternalized in the usual fashion and the body of theuterus cephalad to the hysterotomy incision will bewrapped in sterile surgical towels saturated in sterile,iced normal saline. These towels will come from asterile cooling pot set to 30 degrees Fahrenheit. Theskin of the abdomen will be draped to prevent contactwith the cold towels. Iced saline-soaked towels will bekept in place for a minimum of 5 minutes and replacedat the discretion of the attending obstetrician until thehysterotomy is closed and the uterus is replaced intothe patient's abdomen.
Other intervention name(s): Hetta-UCT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Prevention