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 transverse cervical cesarean birth have advocates, on the basis of theoretic concerns. We sought to study the incidence of complications, including 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 to blunt and sharp expansion groups. Other than expansion of the incision, standard technique was used throughout surgery. Data, including length and number of unintended extensions, vessel laceration, and length of surgery, were recorded immediately.

RESULTS: The blunt (n = 139) and sharp (n = 147) expansion groups were similar with regard to indication and duration of labor. No difference in the incidence of unintended extension, postoperative endometritis, duration of surgery, or estimated blood loss was noted. The frequency of unintended extension (1.4%, 15.5%, and 35.0% for no labor and first and second stages, respectively) correlated with the stage of labor.

CONCLUSION: Blunt and sharp expansions of the uterine incision are equivalent in ease and safety.