Intrauterine Cleaning after Placental Delivery at Cesarean Section: A Systematic Review and Meta-Analysis

Introduction: The increasing rate of cesarean section and its greater number of complications compared to vaginal childbirth invoke efforts to reduce perioperative complications through evidence-based techniques. Objective: The present study mainly aims to assess the effect of intrauterine cleaning after placental delivery in the cesarean section on the frequency of endometritis (primary outcome) and postpartum hemorrhage (secondary outcome). Material and Methods: In this systematic review we have followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both English and Persian databases were searched (with no time limit) for clinical trials and quasi-experimental studies that had investigated the effect of intrauterine cleaning after placental delivery in the cesarean section on the frequency of endometritis and hemorrhage compared to a control group (no intrauterine cleaning). Results: The meta-analysis on three clinical trials with 696 participants showed no significant difference between intervention and control groups in the frequency of endometritis (RR= 1.33; 95% CI: 0.74 to 2.41; P= 0.34) and postpartum hemorrhage (RR= 1.06; 95% CI: 0.55 to 2.06; P= 0.86). Conclusion: Based on the meta-analysis results, intrauterine cleaning after placental delivery in the cesarean section does not affect endometritis and postpartum hemorrhage. Further and more robust studies based on the Consort Declaration are required to investigate this method to be recommended for use in clinical practice.