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

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
• 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
• 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
• 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
• 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
• 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
• 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
• 8 Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: standardizing obstetric data definitions. Obstet Gynecol 2014; 124 (01) 150-153