title: Blunt expansion of the low transverse uterine incision at cesarean delivery: a randomized comparison of 2 techniques.
abstract: OBJECTIVE
  The purpose of this study was to compare 2 methods of expansion of the uterine incision at the time of cesarean delivery.
  
  
  METHODS
  Women who underwent a low-segment transverse cesarean delivery were assigned randomly to have the blunt expansion of the uterine incision by the physician separating the fingers either in a transversal direction or in a cephalad-caudad direction. The primary outcome measure was the incidence of unintended extensions.
  
  
  RESULTS
  The transversal (n = 406) and cephalad-caudad (n = 405) expansion groups were similar with regard to patient characteristics, indication to surgery, type of anesthesia, and proportion of emergency procedures. No difference in the need for transfusions (0.7% vs 0.7%; P = 1.0) or estimated blood loss (440 +/- 341 vs 398 +/- 242 mL; P = .09) was noted. The incidence of unintended extension (7.4% vs 3.7%; P = .03) and blood loss of >1500 mL (2.0% vs 0.2%; P = .04) was significantly higher in the transversal expansion group, compared with the cephalad-caudad group. Transversal expansion was an independent contributor to unintended extension and blood loss of >1500 mL.
  
  
  CONCLUSIONS
  Because it is associated with less risk of unintended extension and excessive blood loss, expansion of the uterine incision with a cephalad-caudad traction should be preferred to transversal expansion when a cesarean delivery is performed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. antonellacromi@libero.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Edoardo
authors.initials: E
authors.lastname: Di Naro
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Loverro
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors