Is cephalad-caudad blunt expansion of the low transverse uterine incision really associated with less uncontrolled extensions to decrease intra-operative blood loss? A prospective randomised-controlled trial

ÖZCAN P., ATEŞ S., Can M. G., Yardimci A. S., BATMAZ G., KILIÇ G.

JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, vol.29, no.12, pp.1952-1956, 2016 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 12
  • Publication Date: 2016
  • Doi Number: 10.3109/14767058.2015.1069813
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1952-1956
  • Keywords: Caesarean section, cephalad-caudad blunt expansion, obstetric haemorrhage, uterine incision, SHARP EXPANSION, HEMORRHAGE
  • Bezmialem Vakıf University Affiliated: Yes


Objective: To determine which type of blunt expansion of a low transverse uterine incision during operative delivery is associated with decreased blood loss and intra- and post-operative morbidity for a caesarean section (CS).Methods: The prospective randomised-controlled trial was conducted at the Department of Obstetrics and Gynecology, Bezmialem University Hospital. The patients were randomly assigned to a group that received a cephalad-caudad (n=55) or transverse (n=57) blunt expansion of the low transverse uterine incision. Intra- and post-operative morbidity at caesarean delivery in short-term including blood loss, operating time, post-operative pain with the faces pain rating scale, and post-operative morbidity were analysed.Results: The changes in both haemoglobin (p<0.01) and haematocrit (p<0.01) from the pre-operative to post-operative values, estimates of blood loss (p<0.01) were significantly lower in cephalad-caudad group and the post-operative haematocrit concentrations (p=0.02) were significantly greater in cephalad-caudad group when compared with the transverse group. The damage of parametrial and uterine vessels into lateral edges were recorded in 11 (19.6%) patients in transverse group and 7 (12.9%) patients in cephalad-caudad group and there is no statistical significance between groups in terms of these parameters (p>0.05, 95% CI 0.19, 1.63).Conclusion: Our findings suggest that cephalad-caudad blunt expansion of the low transverse uterine incision decreases blood loss compared to transverse blunt dissection.