Vertical Splitting of Muscle Layer in Lower Segment Cesarean Sections to Avoid Uterine Vessels Injury

Study Overview
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Brief Summary
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Cesarean section is one of the oldest surgical interventions in the history of medicine.Many variations in cesarean section technique have been studied.The investigatory team are aiming to decrease blood loss during cesarean section by vertical splitting versus transverse cutting of muscle layer in lower segment cesarean sections to avoid uterine vessels injury.

Detailed Description
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Cesarean section is one of the oldest surgical interventions in the history of medicine.Since the first documented cesarean delivery in 1020 AD, various modifications have been made in the technique. It was a surgery performed as a last resort, mostly peri- or post-portem. Many variations in cesarean section technique have been studied.our study aim is to decrease blood loss during cesarean section through decreasing incidence of uterine vessels injury. The investigator supposed that applying Vertical pull on a small C-shaped incision in the lower uterine segment during cesarean section allows the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery.

Official Title
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Comparison Between Vertical Splitting Versus Transverse Cutting of Muscle Layer in Lower Segment Cesarean Sections to Avoid Uterine Vessels Injury: a Randomized Controlled Trial

Conditions
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Cesarean Section Complications

Intervention / Treatment
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* Procedure: Transverse cutting
* Procedure: vertical splitting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elective cesarean section No medical disorders during pregnancy ( Hypertension, DM , ..) No coagulation disorders either congenital nor acquired. Exclusion Criteria: Urgent or emergency cesarean section. Multiple pregnancy. Presence of medical disorders during pregnancy ( Hypertension, DM , ..) Presence of coagulation disorders either congenital nor acquired.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Transverse splitting<br>transverse cutting and/or pulling of lower uterine segment during lower segment cesarean section. | Procedure: Transverse cutting<br>* Transverse cutting and/or pulling.of lower uterine segment during lower cesarean section extending the uterine incision laterally.<br>|
| Active Comparator: Vertical splitting<br>vertical splitting,of lower uterine segment during lower segment cesarean section. | Procedure: vertical splitting<br>* vertical splitting of lower uterine segment during lower cesarean section making the direction of traction up and downward instead of being laterally and we suppose that this will allow the tissues to split along their natural arrangement, decreasing the probability of extension of the wound into the uterine vessels, thus; decreasing blood loss; operative time and maternal recovery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uterine vessels injury | the surgeon performing the cesarean section will detect if injury of uterine vessels occurred or not while extending uterine incision. | 1 minute after extraction of the baby and placenta | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| uterine incision extension | the surgeon performing the cesarean section will detect if uterine incision extension occurred or not after extraction of the baby and the placenta. | 2 minutes extraction of the baby and placenta | 
| intra-operative blood loss | blood loss will be assessed by circulating nurse through counting soaked surgical towels and gauze and calculating estimated blood loss in vacation suction system. | before closure of the abdominal wall layer | 
| postpartum hemorrhage | will be defined by postpartum blood loss of 1000cc | first 24 hours after delivery | 
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain after delivery | 2 hours after delivery | 
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 6 hours after delivery | 
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 12 hours after delivery | 
| postoperative pain | pain scale from 0 to 10 to assess postoperative pain at hours 2 after delivery | 24 hours after delivery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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uterine vessels, vertical splitting, Cesarean Section Complications, injury