Transverse Versus Cephalad – Caudad Blunt Expansion Techniques for Low Transverse Uterine Incision at Cesarean Delivery: Randomized Controlled Trial

Abstract

T his research study was undertaken to determine whether the uterine incision the adverse outcomes during cesarean delivery such as unintended expansion, need for additional stitches, uterine vessels injury and need for intra-operative blood transfusion are affected by the technique used in blunt expansion if uterine incision either cephalad-caudad or transversal one, also the effect of the technique on the drop of Hb level postoperatively. This study was conducted on 392 cases that were undergoing an elective primary cesarean delivery at full term. The patients were randomly allocated into one of two groups: a. Transverse expansion of the uterine incision. b. Cephalad-caudad expansion of the uterine incision. The patients among the two studied groups were matched in regards to the age, parity, and stage of labor. Patients that were undergoing cephalad-caudad expansion of the uterine incision revealed a significant less need for additional stitches with P value =0.017 than the patients that were undergoing transversal expansion. The hemoglobin values for all groups were similar preoperatively, but postoperatively were significantly lower in the transverse expansion of the uterine incision group (P<0.001). The cephalad-caudad expansion has a significant role in decreasing the blood loss during the cesarean delivery. We recommended in this study, cephalad-caudad expansion technique is better than the transversal expansion technique as regard the less need for additional stitches and the less decrease in the postoperative drop in the hemoglobin level, but there was no significant difference regarding unintended extension, uterine vessels injury or need for blood transfusion between both techniques.