Transverse Versus Cephalad ¿ Caudad Blunt Expansion Techniques for Low Transverse Uterine Incision at Cesarean Delivery - Trial PACTR201701001997177

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Summary

Cesarean delivery is the most common and major obstetric operative procedure worldwide Over 90% of cesarean deliveries performed at the lower uterine segment because it is easier to enter the uterine cavity with lesser blood loss comparing with vertical incision Extension of the uterine incision at cesarean delivery usually is performed either sharply by cutting laterally and then slightly upward with bandage scissors or bluntly by tearing the myometrium with the fingers Blunt separation can be either transversely or in cephalad-caudad direction. Scientists have stated that the expansion in the transverse direction could cause sacculation-type defect of uterine wall and increase risk of repeated cesarean section .Alternatively, it was speculated that expansion of uterine incision with a vertical traction might have 2 potential advantages. The first is to avoid greater forward extension of the distal incision because of lack of control of the force magnitude that is applied by the surgeon¿s fingers at the lateral edges of the incision. The second is to minimize tissue trauma by allowing myometrium dissection along natural tissue planes Therefore we will conduct a study to compare 2 methods of expanding the uterine incision (blunt extension by separating the fingers in a transversal vs cephalad-caudad direction) at the time of cesarean delivery as regards unintended extension of the uterine incision primarily and blood loss as a secondary outcome.

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