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Uterine Cooling During Cesarean Delivery to Reduce Blood Loss and Incidence of Postpartum Hemorrhage: A Randomized Controlled Trial [31]

OBJECTIVE: This study seeks to evaluate uterine cooling during cesarean delivery as a novel therapy for uterine atony. METHODS: A randomized controlled trial of women presenting for scheduled cesarean delivery as well as those undergoing cesarean delivery after a trial of labor was conducted. Patients were allocated to the standard procedure or to uterine cooling during hysterotomy repair. The surgery was performed in the usual fashion up until uterine exteriorization for hysterotomy repair. In patients allocated to the uterine cooling group, the uterus was then wrapped in icy laparotomy sponges prepared using a sterile slush machine. Upon completion of the repair, the sponges were removed, and the remainder of the surgery was completed in the usual fashion. Blood loss was objectively calculated by weighing all sponges and measuring the amount of blood in the surgical suction canister. The outcomes assessed were blood loss as well as need for uterotonic medications, blood products, or cesarean hysterectomy. RESULTS: A total of 200 patients were included in the study, 100 in each group. Blood loss in the uterine cooling group was 29% less than the control group (P<.001). The incidence of postpartum hemorrhage was 57% less in the uterine cooling group compared with the control group (P=.02). There was no statistically significant difference in need for uterotonic medications or blood products. No patients underwent cesarean hysterectomy. CONCLUSION: Uterine cooling during cesarean delivery was shown to decrease blood loss and the incidence of postpartum hemorrhage. More research is needed to determine clinical significance of this technique.