Blunt vs sharp uterine expansion at lower segment cesarean section delivery: a systematic review with metaanalysis

Xu, Lileane Liang; Chau, Anthony; Zuschmann, Andrew

doi:10.1016/j.ajog.2012.10.886

Cited by 29 publications

(20 citation statements)

References 15 publications

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“…In an evaluation of CDs performed following labour, the hysterotomy extensions were significantly more common after a prolonged second stage of labour (Sung et al 2007). Variations in surgical technique including blunt versus sharp creation of the hysterotomy have also been assessed (Rodriguez et al 1994; Magann et al 2002; Cromi et al 2008; Sekhavat et al 2010; Xu et al 2013; Asicioglu et al 2014b; Xodo et al 2016). While there is a trend towards a reduced incidence of hysterotomy extensions after blunt creation, this has not been statistically significant in meta-analysis (RR 0.57; 95%CI 0.28–1.17) (Xu et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

Giugale

Sakamoto

Yabes

et al. 2018

Journal of Obstetrics and Gynaecology

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We conducted an observational retrospective cohort study to evaluate the risk factors and the maternal morbidity associated with unintended extensions of the hysterotomy during caesarean delivery. We evaluated 2707 women who underwent low-transverse caesarean deliveries in 2011 at an academic, tertiary-care hospital. Hysterotomy extensions were identified through operative reports. Of the 2707 caesarean deliveries, 392 (14.5%) had an unintended hysterotomy extension. On the multivariable regression modelling, neonatal weight (OR 1.42; 95%CI 1.17-1.73), the arrest of labour [first-stage arrest (2.42; 1.73-3.38); second-stage arrest (5.54; 3.88-7.90)] and a non-reassuring foetal status (1.65; 1.20-2.25) were significantly associated with hysterotomy extensions. Hysterotomy extensions were significantly associated with an increased morbidity including an estimated blood loss >1200 millilitres (2.06; 1.41-3.02), a decline in postoperative haemoglobin ≥3.7 g/dL (2.07; 1.35-3.17), an evaluation for lower urinary tract injury (5.58; 3.17-9.81), and a longer operative time (8.11; 6.33-9.88). Based on these results, we conclude that unintended hysterotomy extensions significantly increase the maternal morbidity of caesarean deliveries. Impact statement What is already known on this subject? Maternal morbidity associated with caesarean delivery (CD) is significantly greater than that in vaginal delivery. Unintended extensions of the hysterotomy occur in approximately 4-8% of CDs and are more common after a prolonged second stage of labour. The morbidity associated with hysterotomy extensions has been incompletely evaluated. What do the results of this study add? We demonstrate a rate of hysterotomy extension in a general obstetric population of approximately 15%, which is higher than previously reported estimates, and represents a potential doubling of the rate of the unintended hysterotomy extensions in recent years. The most significant risk factor for a hysterotomy extension was a second-stage labour arrest with a fourfold increase in the frequency of extensions. A hysterotomy extension is a significant independent risk factor for an intraoperative haemorrhage, a drop in postoperative haemoglobin, an intraoperative evaluation for lower urinary tract injury, and longer CD operative times. What are the implications of these findings for clinical practice and/or further research? A second-stage arrest is a strong independent risk factor for a hysterotomy extension. Recent re-evaluations of the labour curve that extend the second stage of labour will likely increase the frequency of CDs performed after a prolonged second stage. In these scenarios, obstetricians should be prepared for an unintended hysterotomy extension and for the possibility of a longer procedure with the increased risks of blood loss and the need for evaluation of the lower urinary tract.

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Section: Introductionmentioning

confidence: 99%

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

Giugale

Sakamoto

Yabes

et al. 2018

Journal of Obstetrics and Gynaecology

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“…A systematic review and meta-analysis published in 2013 suggested that the addition of data from a new large trial could clarify the clinical differences between the blunt and sharp expansion techniques. 17 Our study found that blunt expansion of the uterine incision is associated with a lower risk for unintended extension than is sharp expansion. Accordingly, the estimated blood loss and duration of the operation also increased with sharp expansion.…”

Section: Discussionmentioning

confidence: 48%

Unintended Extension of the Lower Segment Uterine Incision at Cesarean Delivery: A Randomized Comparison of Sharp versus Blunt Techniques

et al. 2013

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“…The present rate of LUS incision extensions is 4 to 16 folds less that reported with the conventional methods of fetal head extraction 2,3 .…”

Section: Discussionmentioning

confidence: 67%

“…A multitude of efforts had been done aiming at reducing CS related maternal morbidities; most of them are related to technical modifications of how to open and how to close the abdominal and uterine incisions 3 . The comparative studies of blunt versus sharp extension of the uterine incision showed a reduction of the incidence of unintended extension from 8.8% to 4.8% 4 .…”

Section: Introductionmentioning

confidence: 99%

External Pop-out Cesarean Section: A Novel Technique for Supporting the Lower Uterine Segment During Fetal Head Extraction

Saman

Abbas

Ali

et al. 2017

Evidence Based Women's Health Journal

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Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower uterine segment during fetal head extraction in cesarean section (CS). Study design: Prospective cohort study. Patients and Methods:The current research is a registered (NCT02755168) study compassing the new technique, EPO, for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the learning curve of this technique on five senior obstetricians' trainee. Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4 th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001). Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this technique is easily learned and performed by obstetricians.

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Blunt vs sharp uterine expansion at lower segment cesarean section delivery: a systematic review with metaanalysis

Cited by 29 publications

References 15 publications

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

Unintended Extension of the Lower Segment Uterine Incision at Cesarean Delivery: A Randomized Comparison of Sharp versus Blunt Techniques

External Pop-out Cesarean Section: A Novel Technique for Supporting the Lower Uterine Segment During Fetal Head Extraction

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