TY - JOUR
T1 - Significance of accidental extensions in the lower uterine segment during cesarean delivery
AU - de la Torre, Lesley
AU - González-Quintero, Víctor Hugo
AU - Mayor-Lynn, Kathleen
AU - Smarkusky, Loren
AU - Hoffman, M. Camille
AU - Saab, Amanda
AU - Diro, Makbib
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2006/5
Y1 - 2006/5
N2 - Objectives: This study was undertaken to determine risk factors and perioperative complications associated with accidental extensions in the lower uterine segment during cesarean deliveries (CDs). Study design: This is a retrospective chart review of all CDs performed at Jackson Memorial Hospital/University of Miami between the years 1999 and 2002. Operative reports were reviewed to abstract data on the occurrence of extensions. Indication for CD, cervical status at the time of CD, birth weight, and fetal presentation and position were included in the analyses. Postoperative hematocrits, length of surgery, estimated blood loss, decline in hematocrit by 10%, need for transfusion, or hysterectomy were compared among CD with and without extensions. Results: A total of 2,811 CDs were available for this study. Accidental extensions in the lower uterine segment occurred in 6.6% of the cases. Extensions were more commonly found in primary CD (8% vs 5%, P < .01. Extensions were more frequent if cervical dilatation was 8 cm or greater (18.3% vs 7%, P < .01), complete effacement (15% vs 8%, P < .01) station greater than +1 (16% vs 6.9%, P < .01), and if the fetal position was noted to be in the occiput posterior position (10% vs 5%, P < .01). When extensions were present, length of surgery was longer (56 vs 49 minutes, P < .01) and estimated blood loss was greater (994 ± 675 mL vs 936 ± 370 mL, P < .01). Arrest of descent as indication for CD was found to be an independent risk factor for the occurrence of extensions during CD (odds ratio 2.6, 95% CI 1.5-4.5, P = .001). Conclusion: Extensions in the lower uterine segment during CD do not increase maternal morbidity.
AB - Objectives: This study was undertaken to determine risk factors and perioperative complications associated with accidental extensions in the lower uterine segment during cesarean deliveries (CDs). Study design: This is a retrospective chart review of all CDs performed at Jackson Memorial Hospital/University of Miami between the years 1999 and 2002. Operative reports were reviewed to abstract data on the occurrence of extensions. Indication for CD, cervical status at the time of CD, birth weight, and fetal presentation and position were included in the analyses. Postoperative hematocrits, length of surgery, estimated blood loss, decline in hematocrit by 10%, need for transfusion, or hysterectomy were compared among CD with and without extensions. Results: A total of 2,811 CDs were available for this study. Accidental extensions in the lower uterine segment occurred in 6.6% of the cases. Extensions were more commonly found in primary CD (8% vs 5%, P < .01. Extensions were more frequent if cervical dilatation was 8 cm or greater (18.3% vs 7%, P < .01), complete effacement (15% vs 8%, P < .01) station greater than +1 (16% vs 6.9%, P < .01), and if the fetal position was noted to be in the occiput posterior position (10% vs 5%, P < .01). When extensions were present, length of surgery was longer (56 vs 49 minutes, P < .01) and estimated blood loss was greater (994 ± 675 mL vs 936 ± 370 mL, P < .01). Arrest of descent as indication for CD was found to be an independent risk factor for the occurrence of extensions during CD (odds ratio 2.6, 95% CI 1.5-4.5, P = .001). Conclusion: Extensions in the lower uterine segment during CD do not increase maternal morbidity.
KW - Cesarean delivery
KW - Maternal morbidity
KW - Perioperative complications
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=33646114278&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33646114278&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2006.01.026
DO - 10.1016/j.ajog.2006.01.026
M3 - Article
C2 - 16647896
AN - SCOPUS:33646114278
VL - 194
SP - e4-e6
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
SN - 0002-9378
IS - 5
ER -