Cephalad-caudad vs transverse blunt expansion of low transverse hysterotomy during caesarean section and risk of severe postpartum haemorrhage: A prospective comparative study

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 299; pp. 248 - 252
• Main Authors: Sestito, E., Lorain, P., Delorme, P., Kayem, G., Pinton, A.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2024
• Subjects: Adult; Blood transfusion; Blunt expansion; Caesarean section; Cephalad-caudad; Cesarean Section - adverse effects; Cesarean Section - methods; Female; Humans; Hysterotomy; Hysterotomy - adverse effects; Hysterotomy - methods; Postpartum haemorrhage; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - surgery; Pregnancy; Prospective Studies; Transverse; Postpartum haemorrhage; Transverse; Caesarean section; Hysterotomy; Blunt expansion; Cephalad-caudad; Blood transfusion
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.06.004

The frequency of severe postpartum haemorrhage did not differ between cephalad-caudad and transverse blunt expansion hysterotomy. Transverse blunt expansion hysterotomy may be associated with additional sutures after repair of the hysterotomy.. •Caesarean section is a common method of delivery worldwide, accounting for up to 45% of births in some countries.•Caesarean section remains a major cause of maternal morbidity, particularly postpartum haemorrhage (PPH).•The incidence of PPH is higher for caesarean section than vaginal delivery, ranging from 3% to 15%.•As far as the surgical technique is concerned, French guidelines recommend performing blunt expansion of the low transverse hysterotomy with fingers rather than scissors to reduce bleeding.•The preferences for transverse or cephalad-caudal blunt expansion hysterotomy of the low transverse uterine incision during caesarean section differs between countries. The global prevalence of caesarean section as a delivery method is increasing worldwide. However, there is notable divergence among countries in their national guidelines regarding the optimal technique for blunt expansion hysterotomy of the low transverse uterine incision during caesarean section (cephalad-caudad or transverse). To compare the risk of severe postpartum haemorrhage (PPH) between cephalad-caudad and transverse blunt expansion hysterotomy during caesarean section. This prospective comparative observational study was conducted in a university maternity hospital. All women who gave birth to one infant by caesarean section after 30 weeks of gestation between November 2020 and November 2021 were included in this study. The exclusion criteria were a coagulation disorder, the presence of placenta previa, multiple pregnancies, or enlargement of the hysterotomy with scissors. The choice between cephalad-caudad or transverse blunt expansion of the low transverse hysterotomy was left to the surgeon’s discretion. The primary outcome measure was severe PPH, defined as estimated blood loss ≥ 1000 ml. Univariate and multivariate analyses were employed to assess the risk of severe PPH associated with the two methods of enlarging the low transverse hysterotomy. The study included 850 women, of whom 404 underwent transverse blunt expansion and 446 underwent cephalad-caudad blunt expansion. The overall incidence of severe PPH was 13.3 %. Univariate analysis revealed no significant difference in the frequency of severe PPH between the cephalad-caudad and transverse blunt expansion groups (13.9 % vs 12.6 %; p = 0.61). However, the use of additional surgical sutures (mainly additional haemostatic stitches) was less common with cephalad-caudad blunt expansion (26.7 % vs 36.9 %; p < 0.05). Multivariate analysis showed no significant difference in risk between the two techniques (odds ratio 1.17, 95 % confidence interval 0.77–1.78). No significant difference in the risk of severe PPH was found between cephalad-caudad and transverse blunt expansion of the low transverse hysterotomy during caesarean section.