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

J Matern Fetal Neonatal Med. 2016;29(12):1952-6. doi: 10.3109/14767058.2015.1069813. Epub 2015 Aug 13.


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.

Keywords: Caesarean section; cephalad-caudad blunt expansion; obstetric haemorrhage; uterine incision.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Blood Loss, Surgical / prevention & control
  • Blood Loss, Surgical / statistics & numerical data*
  • Cesarean Section / adverse effects*
  • Cesarean Section / methods*
  • Female
  • Humans
  • Pregnancy
  • Prospective Studies
  • Young Adult