Obstetricians differ about whether to routinely exteriorize the uterus to repair it after cesarean delivery or whether to suture the uterine incisionin situ. This randomized study of 288 women undergoing operative delivery compared blood loss and other complications in the 139 patients having exteriorization and in 149 others undergoing repair because the uterus remained intraabdominal. In the former group, the uterus was laid atop the abdominal skin, and the incision was sutured with a double layer of the surgeonrsquo;s choice of material.Hemoglobin levels dropped less when the uterus was exteriorized, and this effect remained significant after adjusting for the changes expected from being in labor, receiving epidural anesthesia, and having blood transfusion. Blood loss also was less than expected when surgery was elective and when a spinal or general rather than an epidural anesthetic was used. There were no significant group differences in the duration of surgery or hospital stay, nor did the surgeons believe that either procedure was easier than the other. Eight women assigned to undergo repairin situdid have the uterus exteriorized, most often because of exposure after a lower segment or angular tear. Four women did not have exteriorization as planned, two in error, one because of bleeding, and one because it proved too difficult to perform. The method of repair did not influence the risk of nausea or vomiting or the scores for tugging and pain at the end of surgery. Two women had an epidural changed to general anesthesia because of pain during exteriorization. Routinely exteriorizing the uterus after cesarean delivery minimizes blood loss without compromising the quality of anesthesia.Br J Obstet Gynaecol 1999;106colon;913ndash;916
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