Irrigation at Cesarean Delivery Likely Unnecessary

Intra-abdominal irrigation during cesarean sections increases intraoperative nausea without decreasing the risk of postoperative infections, according to the findings of a randomized controlled trial.¹ Irrigation of the abdominal cavity is often described as a fundamental step in most obstetrical texts, according to the study authors. However, there is little evidence that this common practice actually improves outcomes.

To determine whether irrigation of the abdominal cavity during cesarean section has any beneficial effects, study participants were randomized to either a no-irrigation group (126 women) or an irrigation group (110 women). The women in the irrigation group underwent irrigation of the abdominal cavity with between 500 to 1000 milliliters of warm normal saline after closure of the hysterectomy but before closure of the abdominal wall. In both groups, all blood clots and other debris were manually evacuated from the paracolic gutters, anterior and posterior cul-de-sacs, and from under the bladder flap. None of the patients were given prophylactic antiemetics. The primary outcome was maternal GI disturbance during the cesarean delivery, defined as intraoperative nausea with or without emesis.

Of the 126 women in the no-irrigation group, 36 (28.26%) reported intraoperative nausea, compared with 51 (46.4%) of the 110 women in the irrigation group. The rate of emesis during surgery was also higher in the irrigation group (26.4% vs 19% in the no-irrigation group), but the difference was not statistically significant.

Two previous studies have reported that irrigation offers no benefit with respect to infections, but neither study found any adverse effects associated with irrigation.^2,3 This newest study is the first to report any harm related to irrigation.¹ The study authors suggest that if by eliminating a practice that could achieve increased levels of patient comfort without introducing any negative consequences, women might report more favorable birth experiences, better newborn bonding, easier initiation of early breastfeeding, and more efficient postoperative recovery.¹

Pertinent Points:
- Intra-abdominal irrigation in cesarean delivery increases intraoperative nausea and offers no benefit for postoperative maternal GI status or maternal infectious morbidity.
- The practice of routine use of irrigation should be questioned and possibly abandoned, suggest the study authors.

References:

1. Viney R, Isaacs C, Chelmow D. Intra-abdominal irrication at cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2012;119:1106-1111.

2. Keblawi A, Dawley BL. Does saline irrigation in the peritoneal cavity at the time of a non-scheduled cesarean section reduce maternal morbidity. Am J Obstet Gynecol. 2006;10:S96.

3. Harrigill KM, Miller HS, Haynes DE. The effect of intraabdominal irrigation at cesarean delivery on maternal morbidity: a randomized trail. Obstet Gynecol. 2003;101:80-85.