title: Unintended extension of the lower segment uterine incision at cesarean delivery: a randomized comparison of sharp versus blunt techniques.
abstract: OBJECTIVE
  This study compared two methods of expanding the uterine incision at the time of cesarean delivery, which is associated with the risk of unintended extension.
  
  
  METHODS
  This randomized trial included 1,076 women who underwent elective cesarean delivery. The primary outcome measure was the incidence of unintended extension related to the method used for expanding the uterine incision.
  
  
  RESULTS
  Participants in both groups (blunt vs. sharp) had similar demographic and clinical characteristics. The incidence of unintended extension (8.8% vs. 4.8%; p = 0.009), mean estimated blood loss (853.67 ± 42 mL vs. 664.80 ± 38 mL; p = 0.001), and blood loss >1000 mL (11.4% vs. 6.8%; p = 0.009) was significantly higher in the sharp group compared with the blunt group. No difference in transfusions (7.5% vs. 6.3%; p = 0.440) or the need for additional supertonic agents (16% vs. 12.9%; p = 0.144) was noted.
  
  
  CONCLUSIONS
  Sharp expansion of the uterine incision was related to a higher risk of unintended extension and maternal blood loss. Because blunt expansion is associated with a lower risk for unintended extension and maternal blood loss, it should be the first option during elective cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Asıcıoglu
authors.affiliation: Kızıltepe State Hospital, Mardin, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey.
authors.forename: Berhan Besımoglu
authors.initials: BB
authors.lastname: Asıcıoglu
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Yıldırım
authors.affiliation: Kızıltepe State Hospital, Mardin, Turkey.
authors.forename: Ozgu Celıkkol
authors.initials: OC
authors.lastname: Gungorduk
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey.
authors.forename: Cemal
authors.initials: C
authors.lastname: Ark
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D014599:Uterus / Q000601:surgery*