title: 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.
abstract: 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).
  
  
  CONCLUSIONS
  Our findings suggest that cephalad-caudad blunt expansion of the low transverse uterine incision decreases blood loss compared to transverse blunt dissection.
authors.affiliation: a Department of Gynaecology and Obstetrics , Bezmialem Vakif University Hospital , İstanbul , Turkey and.
authors.forename: Pinar
authors.initials: P
authors.lastname: Ozcan
authors.affiliation: a Department of Gynaecology and Obstetrics , Bezmialem Vakif University Hospital , İstanbul , Turkey and.
authors.forename: Seda
authors.initials: S
authors.lastname: Ates
authors.affiliation: b Department of Anesthesiology , Acibadem University Hospital , İstanbul , Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Guner Can
authors.affiliation: a Department of Gynaecology and Obstetrics , Bezmialem Vakif University Hospital , İstanbul , Turkey and.
authors.forename: Asli
authors.initials: A
authors.lastname: Sarioglu Yardımcı
authors.affiliation: a Department of Gynaecology and Obstetrics , Bezmialem Vakif University Hospital , İstanbul , Turkey and.
authors.forename: Gonca
authors.initials: G
authors.lastname: Batmaz
authors.affiliation: a Department of Gynaecology and Obstetrics , Bezmialem Vakif University Hospital , İstanbul , Turkey and.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Kilic
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
keywords: Caesarean section; cephalad-caudad blunt expansion; obstetric haemorrhage; uterine incision