Blunt expansion of the low transverse uterine incision at cesarean delivery: a randomized comparison of 2 techniques

Antonella Cromi, Fabio Ghezzi, Edoardo Di Naro, Gabriele Siesto, Giuseppe Loverro, Pierfrancesco Bolis

Research output: Contribution to journalArticlepeer-review


Objective: The purpose of this study was to compare 2 methods of expansion of the uterine incision at the time of cesarean delivery. Study Design: 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. Conclusion: 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.

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Issue number3
Publication statusPublished - Sep 2008


  • bleeding
  • cesarean delivery
  • expansion of uterine incision
  • extension
  • surgical technique

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynaecology


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