BLUNT VERSUS SHARP EXPANSION OF THE UTERINE INCISION IN LOW-SEGMENT TRANSVERSE CESAREAN-SECTION

OBJECTIVE: Both blunt and sharp expansion of the initial incision at t ransverse cervical cesarean birth have advocates, on the basis of theo retic concerns. We sought to study the incidence of complications, inc luding unintended extension, associated with each of these methods by comparison by means of a prospective, randomized study. STUDY DESIGN: Women scheduled to undergo nonemergency cesarean birth were assigned t o blunt and sharp expansion groups. Other than expansion of the incisi on, standard technique was used throughout surgery. Data, including le ngth and number of unintended extensions, vessel laceration, and lengt h of surgery, were recorded immediately. RESULTS: The blunt (n = 139) and sharp (n = 147) expansion groups were similar with regard to indic ation and duration of labor. No difference in the incidence of uninten ded extension, postoperative endometritis, duration of surgery, or est imated blood loss was noted. The frequency of unintended extension (1. 4%, 15.5%, and 35.0% for no labor and first and second stages, respect ively) correlated with the stage of labor. CONCLUSION: Blunt and sharp expansions of the uterine incision are equivalent in ease and safety.