الفهرس 
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Abstract
Non-labor elective caesarean section has increased in low-, middle-, and high-income countries. In Egypt, the rate of CS is about 52% of all deliveries according to the latest reports. Many modalities has been tried to reduce postpartum morbidity.
Some obstetricians believe that dilating the cervix helps the drainage of blood from the uterus, following birth by planned caesarean section before the onset of labor. Increased drainage may reduce the risk of intrauterine infection and postpartum hemorrhage. On the other hand, mechanically opening the cervix could result in contamination of the uterus with vaginal micro-organisms, and increase the risk of infections or cervical trauma.
The aim of this study was to assess the effect of transabdominal cervical dilatation during elective CS in decreasing the incidence of postpartum endometritis.
This is a randomized controlled clinical trial was carried at the labor ward of the Ain-Shams University Maternity Hospital, in the period from august 2020 to February 2021. 220 patients met all inclusion and exclusion criteria and were included in the study. The patients was divided into 2 groups: group (A) (N=110): CS with mechanical cervical dilatation and group (B) (N=110): CS without cervical dilatation.
There was no statistically significant difference between both groups regarding parity and previous history of Cs. There was no statistically significant difference between both groups regarding gestational age. There was no statistically significant between both groups regarding developing postpartum endometritis. One patient in-group A (with cervical dilatation) developed postpartum endometritis manifested by fever, abdominal pain and offensive vaginal discharge. The diagnosis was confirmed by complete blood picture and blood culture. One patient in group B (without cervical dilatation) developed postpartum endometritis manifested by fever , abdominal pain and offensive vaginal discharge. The diagnosis was confirmed by complete blood picture and blood culture.
There was no statistically significant between both groups regarding wound sepsis. Six patients in group A (with cervical dilatation) developed wound sepsis. Four patients in the form of seroma, three of them were small and eventually resolved spontaneous with no need for further intervention and one large seroma that required external drainage using syringe needle. One patients developed wound cellulitis that resolved with repeated dressing using topical antibiotic (bivatracin). One patient suffered from wound dehiscence that was treated by repeated dressing followed by secondary sutures.
Four patients in group B (without cervical dilatation) developed wound sepsis. Three patients in the form of seroma that were small and resolved spontaneous with no need for further intervention. One patient developed wound abscess that was drained surgically.
There was no statistically significant difference between both groups regarding hemoglobin drop.
There was no statistically significance difference between both groups regarding postoperative hospital stay.
None of patients in both groups developed cervical injury during transabdominal cervical dilatation during elective CS.There was no statistically significance difference between both groups regarding transabdominal mechanical dilatation of cervix during elective CS and cervical injury during dilatation.
We concluded that dilatation of the cervix during cesarean section compared with no dilatation of the cervix did not influence the risk of postpartum endometritis, wound infection, DROP between preoperative and postoperative hemoglobin and postoperative hospital stay.
It is recommended that further research is needed using a larger sample size or retrograde follow up of postpartum endometritis patients to see if they underwent transabdominal mechanical dilatation of cervix during their elective CS or not.