MATERNAL BLOOD LOSS BY EXPANSION OF UTERINE INCISION AT CAESAREAN SECTION–A COMPARISON BETWEEN SHARP AND BLUNT TECHNIQUES
AbstractBackground: In order to minimize intra operative blood loss during caesarean section, two techniques of expansion of uterine incision (sharp versus blunt) while performing lower segment transverse caesareans deliveries and their effect upon intraoperative blood loss were studied. Moreover, each method was also compared for its inadvertent extension of uterine incision laterally or into the broad ligament, into the cervix or vagina. Method: A quasi-experimental study with convenient sampling, involving two groups of women who underwent lower transverse segment Cesarean section. Both groups were studied for their demographic characteristics and clinical data. Standard surgical techniques were used in both groups except the expansion of uterine incision, either by sharp or blunt methods. Finally a comparison of two groups was made regarding blood loss, change in haematocrit, blood transfusion and uterine tears. The study was conducted at Combined Military Hospital Rawalpindi during May 2002 to April 2003. Results: No significant difference was found between the two groups regarding their demographic characteristics and clinical data. Intraoperative blood loss and post-operative hematocrit drop were more significant in the patient group in which a blunt uterine incision was made. Besides, more patients in this group received blood transfusions. Unintended extension of uterine (tears) was also significantly higher in this group. Conclusion: Sharp expansion of uterine incision during low segment caesarean section is safer and precise based on these results.Key words: Caesarean section, surgical techniques, uterine incision.
Fikree FF, Midhet F, Sadruddin S, Berendes HW. Maternal mortality in different Pakistani sites: ratios, clinical causes and determinants. Acta Obstet Gynecol Scand 1997; 76(7): 637-45
Jafarey SN. Maternal mortality in Pakistan--compilation of available data. J Pak Med Assoc 2002; 52(12): 539-44
ACOG educational bulletin. Postpartum hemorrhage. Number 243, January 1998(replaces No. 143, July 1990). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998;61(1):79-86.
Naef RW 3rd, Chauhan SP, Chevalier SP, Roberts WE, Meydrech EF, Morrison JC. Prediction of hemorrhage at cesarean delivery. Obstet Gynecol 1994;83(6):923-6
Field CS. Surgical techniques for cesarean section. Obstet Gynecol Clin North Am 1988; 15(4): 657-72
Bergholt T, Stenderup JK, Vedsted-Jakobsen A, Helm P, Lenstrup C. Intra-operative surgical complication during cesarean section: an observational study of the incidence and risk factors. Acta Obstet Gynecol Scand 2003;82(3): 251-6
Magann EF, Washburne JF, Harris RL, Bass JD, Duff WP, Morrison JC. Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair. J Am Coll Surg 1995;181(6): 517-20
Boyle JG, Gabbe SG. T and J vertical extensions in low transverse cesarean births. Obstet Gynecol 1996; 87(2): 238-43
Wallin G, Fall O. Modified Joel-Cohen technique for caesarean delivery. Br J Obstet Gynaecol 1999;106(3): 221-6
Rodriguez AI, Porter KB, O'Brien WF. Blunt versus sharp expansion of the uterine incision in low-segment transverse caesarean section. AM J Obstet Gynecol 1994;171:1022-5
Magann EF, Chauhan SP, Bufkin L, Field K, Roberts WE, Martin JN Jr. Intra-operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomized clinical trial. BJOG 2002;109(4):448-52
Jovanovic R. Incisions of the pregnant uterus and delivery of low-birth weight infants. Am J Obstet Gynecol 1985;152(8): 971-4
Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. BJOG 2002;109(4):448-52.