Top

Published in:

01-01-2017 | Maternal-Fetal Medicine

Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial

Authors: Jade Kirscht, Christel Weiss, Jana Nickol, Sebastian Berlit, Benjamin Tuschy, Benjamin Hoch, Amelie-Verena Trebin, Thomas Große-Steffen, Marc Sütterlin, Sven Kehl

Published in: Archives of Gynecology and Obstetrics | Issue 1/2017

Abstract

Purpose

To assess the effects of mechanical dilatation of the cervix during cesarean section on postoperative morbidity.

Methods

A total of 447 women with elective cesarean section were included in the Dondi trial (Dilatation or no dilatation of the cervix during cesarean section). The primary outcome measure of this randomized controlled trial was postpartum hemorrhage (PPH) within 6 weeks. Infectious morbidity (puerperal fever, endometritis, wound infection, and urinary tract infection), blood loss (need for blood transfusion or change in hemoglobin levels), and operating time were also evaluated.

Results

The rate of PPH within 6 weeks was not different between the two groups [dilatation group: 5 (2.4 %), no dilatation group: 3 (1.2 %), p = 0.479]. Infectious morbidity, blood loss, and operating time were not diverse as well. The only significant difference between the two groups was the rate of retained products of conception with fewer cases after cervical dilatation (0 versus 6.2 %, p < 0.001).

Conclusions

Dilatation of the cervix during cesarean section compared with no dilatation of the cervix did not influence the risk of postpartum hemorrhage. However, there were fewer cases with retained products of conception after dilatation.

Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM (2015) Section WHOWGoC. WHO Statement on cesarean section rates. BJOG

Allen VM, O’Connell CM, Liston RM, Baskett TF (2003) Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol 102(3):477–482PubMed

Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP (2013) Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 209(4):294–306CrossRefPubMed

Group CC, Abalos E, Addo V, Brocklehurst P, El Sheikh M, Farrell B et al (2013) Cesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial. Lancet 382(9888):234–248CrossRef

Ahmed B, Abu Nahia F, Abushama M (2005) Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study. J Perinat Med 33(6):510–513CrossRefPubMed

Gungorduk K, Yildirim G, Ark C (2009) Is routine cervical dilatation necessary during elective cesarean section? A randomised controlled trial. Aust N Z J Obstet Gynaecol 49(3):263–267CrossRefPubMed

Tosun M, Sakinci M, Celik H, Torumtay B, Yazici E, Alper T et al (2011) A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section. Arch Gynecol Obstet 284(1):85–89CrossRefPubMed

Liabsuetrakul T, Peeyananjarassri K (2011) Mechanical dilatation of the cervix at non-labour cesarean section for reducing postoperative morbidity. Cochrane Database Syst Rev 11:CD008019

Berlit S, Nickol J, Weiss C, Tuschy B, Mayer J, Sutterlin M et al (2013) Cervical dilatation and curettage in elective cesarean section. A retrospective analysis. Vivo 27(5):661–665

10.

Brocklehurst P, Quigley M, Ayers S, Juszczak E, Anderson E, Bowler U et al. (2010) Cesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG 117(11):1366–1376CrossRef

11.

Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD (2008) Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 199(1):36 e1–15 discussion 91-2 e7-11 CrossRef

12.

Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B (2008) Prevalence and risk factors of severe obstetric hemorrhage. BJOG 115(10):1265–1272CrossRefPubMed

13.

Bergholt T, Stenderup JK, Vedsted-Jakobsen A, Helm P, Lenstrup C (2003) Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors. Acta Obstet Gynecol Scand 82(3):251–256CrossRefPubMed

14.

Bollapragada SS, Edozien LC (2002) Apparent absence of lochia after elective cesarean section. J Obstet Gynaecol 22(5):558CrossRefPubMed

15.

Koifman A, Harlev A, Sheiner E, Press F, Wiznitzer A (2009) Routine cervical dilatation during elective cesarean delivery—Is it really necessary? J Matern Fetal Neonatal Med 22(7):608–611CrossRefPubMed

Title: Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial
Authors: Jade Kirscht
Christel Weiss
Jana Nickol
Sebastian Berlit
Benjamin Tuschy
Benjamin Hoch
Amelie-Verena Trebin
Thomas Große-Steffen
Marc Sütterlin
Sven Kehl
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 1/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-016-4189-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Laparoscopic hysterectomy in the overweight and obese: does 3D imaging make a change?

Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery

Randomized double-blind placebo controlled study of preinduction cervical priming with 25 µg of misoprostol in the outpatient setting to prevent formal induction of labour

Reviewers 2016

Part-time employment of gynecologists and obstetricians: a sub-group analysis of a Germany-wide survey of residents

Prognostic factors in endometrial clear cell carcinoma