Am J Perinatol 2019; 36(10): 1054-1059
DOI: 10.1055/s-0038-1676112
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors and Maternal Morbidity Associated with Unintentional Hysterotomy Extension at the Time of Cesarean Delivery

Katherine H. Bligard
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Jennifer K. Durst
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
2   Department of Obstetrics and Gynecology, Ochsner Medical Center, New Orleans, Louisiana
,
Molly J. Stout
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Shannon Martin
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Methodius G. Tuuli
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Weitere Informationen

Publikationsverlauf

25. Februar 2018

16. Oktober 2018

Publikationsdatum:
30. November 2018 (online)

Abstract

Objective Our aim was to estimate the incidence of unintentional hysterotomy extension at the time of cesarean delivery and to identify associated risk factors and maternal morbidity.

Study Design We conducted a secondary analysis of a randomized controlled trial evaluating chlorhexidine-alcohol versus iodine-alcohol for skin antisepsis in women undergoing cesarean delivery. We included patients with a low transverse hysterotomy. The primary outcome was the incidence of unintentional hysterotomy extension. Logistic regression was performed to identify independent factors associated with hysterotomy extension. Maternal morbidity was compared between patients with and without extension.

Results Of 1,038 patients meeting the inclusion criteria, 71 (6.8%; 95% confidence interval [CI]: 5.4–8.5%) experienced a hysterotomy extension. Of several potential risk factors assessed, the second stage of labor was the only independent predictor of hysterotomy extension (adjusted odds ratio: 10.2; 95% CI: 2.6–39.8). Hysterotomy extension was associated with increased operative time (73 vs. 55.3 minutes; p< 0.01), need for blood transfusion (relative risk: 5; 95% CI: 1.6–15.2), and rate of additional surgical injury (RR: 17; 95% CI: 6.9–41.8).

Conclusion Hysterotomy extensions are not infrequent at the time of cesarean delivery and are associated with increased maternal morbidity. Cesarean delivery during the second stage of labor is the main independent risk factor for hysterotomy extension.

 
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