Abstract
Introduction The main advantage of extraperitoneal cesarean section
(EXPCS) is not only less pain, faster recovery, and less potential for infection
but also a possible lack of intraperitoneal adhesions.
Methods In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A
comparison was made with 90 patients who underwent a standard transperitoneal
cesarean section (TPCS). For both groups, the inclusion criterion was uterine
inertia and prolonged labor as an indication for cesarean section. Only pregnant
women from 37 to 42 weeks were included. After this, 51 patients remained in the
EXPCS arm, and 49 remained in the TPCS arm.
Results No statistical difference was found in gestational weeks, newborn
weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc)
values and duration of operative time between the EXPCS and TPCS groups.
Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the
third postoperative day were found statistically significantly (p=0.005) higher
in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after
delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically
significantly (p<0.05) higher in the TPCS group. On the visual analog scale
(VAS) 24 hours after surgery, a statistically significant difference was found
(p = 0.001) between the two groups. In the small group of patients who underwent
a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in
another group of patients who underwent a TPCS twice, adhesions were found in 12
patients; Fisher's exact test (p=0.04).
Conclusion The protective effect of EXPCS for infection could be proven
in prolonged delivery. EXPCS could be a good solution in the fight against
adhesions and infection in women who undergo second, third, or even fourth
cesarean sections.
Keywords
cesarean section - obstetrics - uterus
