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Original Papers

Complications of blunt versus sharp expansion of the uterine incision in lower segment caesarean section. A randomized controlled trial

Authors:

D. M. C. S. Jayasundara ,

University of Peradeniya, Peradeniya, LK
About D. M. C. S.

Teaching Hospital Peradeniya

MBBS, MD, MRCOG

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R. N. G. Rajapakse

Colombo Teaching Hospital, Ragama, LK
About R. N. G.
MBBS, MS
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Abstract

Introduction: Caesarean section has now become the most frequently performed major surgical procedure in women in the field of Obstetrics and Gynaecology. There is however a wide variation in the surgical technique of caesarean section. Our objective was to compare incidence of complications associated with blunt versus sharp expansion of the uterine incision at the time of caesarean section.

Methods: 274 women who underwent a lower segment caesarean section at North Colombo Teaching Hospital, Ragama was assigned randomly to have the expansion of the primary uterine incision either bluntly using the index fingers of both hands of the surgeon or sharply using a curved scissors. Rest of the surgery was performed alike in all participants.

Results: The blunt expansion group (n=141) and the sharp expansion group (n=133) were similar with regard to age distribution, BMI, parity, history of previous LSCS and proportion of elective or emergency procedures and the cervical dilatation at the time of LSCS. The incidence of inadvertent extensions (42.1% vs 28.4%; p=0.02) and the mean time taken to repair the uterine incision (14.9min vs 13.7min; p=0.03) was significantly higher in the blunt expansion group compared to the sharp expansion group. The percentage drop in haematocrit more than 10% (30.8% vs 28.4%; p=0.48) and the drop in haemoglobin more than 2g/dl (22.6% vs 20.6%; p=0.47) was not significantly different in the blunt expansion group compared to the sharp expansion group. Incidence of inadvertent extensions was significantly different (38.5 vs 24.1; p=0.03) during elective LSCS but not during emergency LSCS (50% vs 44.8%; p=0.67) between the blunt expansion group and sharp expansion group. The incidence of inadvertent extensions was significantly higher (36.5% vs 24%; p=0.03) when the cervical dilatation was less than 4cm at the time of LSCS in the blunt expansion group compared to the sharp expansion group. Blunt expansion group required more blood pint transfusions when compared to the sharp expansion group (6 vs 2).

Conclusion: The sharp expansion of the uterine incision at the time LSCS is associated with a lower risk of inadvertent extensions as well as extensions into broad ligament and uterine vessels compared to the blunt expansion method.

The sharp expansion of the uterine incision is preferable to blunt expansion during LSCS and its advantage is more evident during elective LSCS than during emergency LSCS and when the cervical dilatation was less than 4cm at the time of LSCS.
DOI: http://doi.org/10.4038/sljog.v37i4.7772
How to Cite: Jayasundara, D.M.C.S. & Rajapakse, R.N.G., (2016). Complications of blunt versus sharp expansion of the uterine incision in lower segment caesarean section. A randomized controlled trial. Sri Lanka Journal of Obstetrics and Gynaecology. 37(4), pp.60–64. DOI: http://doi.org/10.4038/sljog.v37i4.7772
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Published on 14 Jun 2016.
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