Intrauterine Cleaning After Placental Delivery at Cesarean Section

To evaluate whether omission of intrauterine cleaning increases intraoperative and postoperative complications among women who deliver via cesarean section. We randomized 206 women undergoing primary elective cesarean deliveries to intrauterine cleaning or omission of cleaning. Patients with spontaneous rupture of membranes before cesarean section, chorioamnionitis, poorly controlled diabetes mellitus, and immunosuppressive disorders were excluded. Postpartum endomyometritis rates were compared across groups as the primary outcome in an intention-to-treat analysis. We also examined a number of secondary outcomes. To detect a 20% difference in infection rate between the cleaned and the non-cleaned groups (two-tailed [α]=0.05, [β]=0.2), 103 women were required per group. From June 2014 through July 2015, 312 women were screened and 206 were randomized as follows: 103 to intrauterine cleaning and 103 to omission of cleaning after placental delivery. Most characteristics were similar among groups. There were no statistically significant differences in the rate of endomyometritis between the two groups (2.0% vs 2.9%, RR 0.60; 95% CI 0.40-1.32). There were no statistically significant differences in postpartum hemorrhage rates (5.8% vs 7.7%, RR 0.75; 95% CI 0.6-1.2), hospital readmission rates (2.9% vs 3.8%, RR 0.75; 95% CI 0.5-1.6), mean surgical time, hospital length of stay, time to return of gastrointestinal function, need for repeat surgery, or quantitated blood loss between the two groups. Our randomized controlled trial provides evidence suggesting that omission of intrauterine cleaning during cesarean deliveries in women at low risk of infection does not increase intraoperative or postoperative complications.