Objective

To compare two different blunt extension techniques of the lower segment transverse uterine incision at cesarean delivery in women with a uterine scar of previous cesarean delivery.

Methods

Study design: Prospective single-blinded parallel multi-center randomized controlled trial involving 392 cases equally divided into two groups. Group one had their incision extended transversely, while group two had their incision extended longitudinally. Outcome measures: The primary outcome was the unintended extension of the uterine incision, while the secondary outcomes included the need for additional stitches to achieve hemostasis, the drop in hemoglobin level, uterine vessels injury, and the need for blood transfusion.

Results

No significant difference between the transverse and longitudinal extension of the uterine incision during cesarean section as regards unintended uterine extension (P=0.860), uterine vessel injury (P=0.501), and cases requiring blood transfusion (P=0.814). Significantly lower drop in hemoglobin level (P≤0.001) and significantly less need for additional stitches (P≤0.001) in cases with the longitudinal extension of uterine incision.

Conclusion

In women with a uterine scar of previous cesarean delivery, the blunt longitudinal extension of the uterine incision in the lower segment cesarean section didn't differ from the blunt transverse extension as regards unintended uterine extension but is associated with less hemoglobin drop and less need for additional stitches as compared to transverse extension of the incision. Further studies are needed to assess the long-term complications of both techniques.

中文翻译：

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既往剖宫产有子宫瘢痕的女性剖宫产期间子宫切口横向与纵向钝性延伸：一项随机对照试验

客观的

比较两种不同的钝性延长技术，用于剖宫产时子宫下段横切口，用于既往剖宫产有子宫瘢痕的女性。

方法

研究设计：前瞻性单盲平行多中心随机对照试验，涉及 392 例病例，平均分为两组。第一组切口横向延伸，第二组切口纵向延伸。结果测量：主要结果是子宫切口的意外延伸，而次要结果包括需要额外缝合以实现止血、血红蛋白水平下降、子宫血管损伤和需要输血。

结果

剖宫产术中子宫切口横向和纵向延伸在意外子宫扩张（P =0.860）、子宫血管损伤（P =0.501）和需要输血的情况（P =0.814）方面差异无统计学意义。在子宫切口纵向延伸的情况下，血红蛋白水平的下降显着降低（P ≤0.001），并且对额外缝线的需求显着减少（P ≤0.001）。

结论

在先前剖宫产有子宫瘢痕的女性中，剖宫产下段子宫切口的钝性纵向延伸与意外子宫延伸的钝性横向延伸没有区别，但与较少的血红蛋白下降和较少需要相关与切口的横向延伸相比，额外缝线。需要进一步的研究来评估这两种技术的长期并发症。