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Am J Perinatol 2019; 36(08): 785-789
DOI: 10.1055/s-0038-1676827
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery

Soha S. Patel
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Nathanael C. Koelper
2   Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Sindhu K. Srinivas
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Mary D. Sammel
3   Division of Biostatistics, Epidemiology, and Informatics, Department of Obstetrics and Gynecology, Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Lisa D. Levine
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations Funding This work was funded, in part, by a National Institute of Health career development award in Women's Reproductive Health Research (K12-HD001265-15).
Further Information

Publication History

24 May 2018

21 October 2018

Publication Date:
15 January 2019 (online)

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Abstract

Objective We sought to compare adverse maternal outcomes between women with and without a uterine extension at the time of cesarean.

Study Design We conducted a retrospective cohort study of women with and without a uterine extension during a primary low transverse cesarean of a full-term singleton gestation. The primary outcomes were (1) estimated blood loss (EBL) and (2) composite maternal morbidity (defined as ≥ 1 of the following: blood transfusion, endometritis, or readmission). Pearson's chi-square or Fisher's exact test was used to compare categorical data; Student's t-test or Mann–Whitney's U-tests was used for continuous data. Linear and logistic regressions were used to adjust for confounding factors.

Results There were 252 women included (126 with extension and 126 without an extension). Women with extensions had a higher EBL (1,038 vs. 832 mL, p < 0.001) and higher rate of the composite maternal morbidity (19.1 vs. 5.6%, p = 0.001). Additionally, women with extensions had an increased risk of postpartum hemorrhage ≥ 1 L (53.2 vs. 23.8%, p < 0.001) and 1.5 L (12.7 vs. 0%, p < 0.001) and were associated with prolonged length of hospital stay (29 vs. 17%, p = 0.04).

Conclusion Uterine extensions are associated with adverse maternal outcomes including higher EBL and increase in maternal morbidity.

Keywords

blood transfusion - cesarean delivery - extension - maternal morbidity - postpartum hemorrhage
 

  • References

  • 1 Asıcıoglu O, Gungorduk K, Asıcıoglu BB, Yıldırım G, Gungorduk OC, Ark C. Unintended extension of the lower segment uterine incision at cesarean delivery: a randomized comparison of sharp versus blunt techniques. Am J Perinatol 2014; 31 (10) 837-844
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. National Center for Health Statistics: Births – Methods of Delivery. 2016 ;67(1). Available at: https://www.cdc.gov/nchs/fastats/delivery.htm . Accessed April 8, 2018
    PubMedGoogle Scholar
  • 3 Creanga AA, Bateman BT, Butwick AJ. , et al. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?. Am J Obstet Gynecol 2015; 213 (03) 384.e1-384.e11
    CrossrefPubMedGoogle Scholar
  • 4 Hammad IA, Chauhan SP, Magann EF, Abuhamad AZ. Peripartum complications with cesarean delivery: a review of Maternal-Fetal Medicine Units Network publications. J Matern Fetal Neonatal Med 2014; 27 (05) 463-474
    CrossrefPubMedGoogle Scholar
  • 5 Belfort MA, Clark SL, Saade GR. , et al. Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. Am J Obstet Gynecol 2010; 202 (01) 35.e1-35.e7
    CrossrefPubMedGoogle Scholar
  • 6 Sung JF, Daniels KI, Brodzinsky L, El-Sayed YY, Caughey AB, Lyell DJ. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol 2007; 197 (03) 306.e1-306.e5
    CrossrefPubMedGoogle Scholar
  • 7 de la Torre L, González-Quintero VH, Mayor-Lynn K. , et al. Significance of accidental extensions in the lower uterine segment during cesarean delivery. Am J Obstet Gynecol 2006; 194 (05) e4-e6
    CrossrefPubMedGoogle Scholar
  • 8 Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: standardizing obstetric data definitions. Obstet Gynecol 2014; 124 (01) 150-153
    CrossrefPubMedGoogle Scholar