Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries

Luthra, Gauri; Gawade, Prasad L.; Starikov, Roman; Markenson, Glenn

doi:10.3109/14767058.2013.811226

Cited by 25 publications

(14 citation statements)

References 9 publications

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“…Also in our study there were no cases of fetal injury in any of the studied groups. This finding is in accordance with Luthra [14] in their retrospective cohort study of singleton cesarean deliveries from 2002 to 2009, they observed no difference in neonatal complications between vertical and transverse incision. However in contrary to our results Alexander et al [15] in a prospective cohort study conducted in 13 university hospitals to describe the fetal outcome in women undergoing CS.…”

Section: Inverted "T" Incision Restricted To Lower Uterine Segment Assupporting

confidence: 90%

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2016

MOJWH

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Background: Cesarean section (CS) rates have been increasing worldwide. Many complications may arise during uterine entry in patients with previous CS due to scarring and loss of lower segment elasticity hence the need for development of a safer surgical technique.Objectives: to evaluate a new surgical technique of uterine entry during CS through elective inverted T incision in lower uterine segment (LUS) in patients with repeated cesarean section/s. Setting:Obstetrics & Gynecology Department of Al Azhar University Hospital. Patients and methods:A total of 120 term cephalic singleton pregnant women with previous cesarean section/s were randomized in to 2 groups. a) Group A: 60 patients for whom elective CS with the new technique of Inverted T lower segment CS (LSCS) was performed.b) Group B: 60 patients for whom curvilinear LSCS was performed.Results: Elective inverted T incision was associated significantly with decrease incidence of angles extension, broad ligament hematoma and injury of LUS (1.7% vs. 11.7% p =0.028), (0.0% vs. 6.7% p =0.042) and (0.0% vs. 6.7% p = 0.042) for group A & B respectively. At the start of the study it was associated significantly with increased amount of blood loss and longer duration of CS (495.7 ± 47.9 cc vs. 417.4 ± 34.9 cc, and 47.6 ± 5.5 Vs. 38.97 ± 4.1 minutes p= 0.001 for A & B respectively), however by study progression the difference become statistically insignificant (p=0.058). The new technique did not increase incision-delivery interval or fetal morbidity (p>0.05). Conclusion:Our new technique of inverted "T" incision restricted to LUS during Elective CS significantly decreased the incidence of angles extension, broad ligament hematoma and lower segment injury. It avoids upper segment and lateral extension without affection of operation time or blood loss. It is a safer technique for mother and fetus in scared LUS due to repeated CS.

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Section: Inverted "T" Incision Restricted To Lower Uterine Segment Assupporting

confidence: 90%

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2016

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“…Prior studies have found increased risks of postpartum hemorrhage and blood transfusion in women undergoing classical cesarean delivery, 6, 7, 9, 10 although other studies did not find an increased risk. 4, 8 This conflicting data might be due to different inclusion criteria (term versus preterm).…”

Section: Commentmentioning

confidence: 88%

“…In a previous study, classical cesarean delivery was not associated with improved short-term neonatal outcomes compared with low transverse cesarean delivery. 10 In the long-term, it is well known that classical cesarean delivery is associated with an increased risk of uterine rupture and uterine scar dehiscence compared with low transverse cesarean delivery. 8, 14, 15 Also subsequent pregnancies require cesarean delivery at late preterm or early term due to the risk of scar dehiscence, which raises concern for abnormal placental implantation and neonatal respiratory complications.…”

Section: Commentmentioning

confidence: 99%

Maternal outcomes associated with early preterm cesarean delivery

Kawakita

Reddy

Grantz

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Data on complications associated with classical cesarean delivery are conflicting. In extremely preterm cesarean delivery (22 0/7–27 6/7 weeks’ gestation), the lower uterine segment is thicker. It is plausible that the rates of maternal complications may not differ between classical and low transverse cesarean. Objective To compare maternal outcomes associated with classical comparing with low transverse cesarean after stratifying by gestation (23 0/7–27 6/7 and 28 0/7–31 6/7 weeks’ gestation). Study design We conducted a multi-hospital retrospective cohort study of women undergoing cesarean delivery at 23 0/7–31 6/7 weeks’ gestation between 2005 and 2014. Composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, respiratory complications, and Intensive Care Unit admission) was compared between classical and low transverse cesarean. Outcomes were calculated using multivariable logistic regression models yielding adjusted odds ratios with 95% confidence intervals and adjusted p-values controlling for maternal characteristics, emergency cesarean delivery, and comorbidities. Analyses were stratified by gestational age categories (23 0/7–27 6/7 and 28 0/7–31 6/7 weeks’ gestation). Results Of 902 women, 221(64%) and 91 (16%) underwent classical cesarean between 23 0/7 and 27 6/7 and between 28 0/7 and 31 6/7 weeks’ gestation, respectively. There was no increase in maternal complications for classical cesarean compared to low transverse cesarean between 23 0/7 and 27 6/7 weeks’ gestation. However, between 28 0/7 and 31 6/7 weeks’ gestation, classical cesarean was associated with increased risks of the composite maternal outcome (adjusted odds ratio=1.95; 95% confidence interval=1.10–3.45), transfusion (adjusted odds ratio=2.42; 95% confidence interval=1.06–5.52), endometritis (adjusted odds ratio=3.23; 95% confidence interval=1.02–10.21), and Intensive Care Unit admission (adjusted odds ratio=5.05; 95% confidence interval=1.37–18.52) compared to low transverse cesarean. Conclusion Classical cesarean delivery compared with low transverse was associated with higher maternal complication rates between 28 0/7 and 31 6/7 weeks, but not between 23 0/7 and 27 6/7 weeks’ gestation.

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“…found an increased odds of blood transfusion in 187 CCD compared with 586 LTCD (OR=2.17, 95% CI 1.0–4.67). 9 Patterson et al in a 19-year review of all cesarean deliveries in the Nova Scotia Atlee Provincial Database (1980–1998) found that puerperal infection, blood transfusion, hysterectomy, intensive care unit admission, death) were each significantly higher in 221 CCD compared with 19,422 LTCD. However, the mean gestational age at delivery was significantly higher in the LTCD group (38.8 weeks of gestation) than the CCD group (31.6 weeks of gestation).…”

Section: Commentmentioning

confidence: 99%

“…6–10 Several mostly small studies have evaluated the relationship of preterm delivery (including variation across gestational age) and route of delivery to postpartum maternal morbidity. 5,8,9,11 The data comparing postoperative morbidity in classical versus low segment cesarean delivery in the early preterm period are also extremely limited. 5,8,9,11 The objectives of this analysis were to determine the prevalence of serious maternal complications associated with early preterm delivery by gestational age (GA) and to determine rates of serious maternal complications by route of delivery (vaginal delivery (VD); classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD) and low vertical cesarean delivery (LVCD) by using highly detailed data obtained by chart abstraction by trained research personnel.…”

Section: Introductionmentioning

confidence: 99%

Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

Reddy

Rice

Grobman

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3.77), and 10.3% of LVCD (aRR 2.27, 95%CI 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR 1.37, 95%CI 0.95–1.97) or between CCD and LVCD (aRR 1.56, 95%CI 0.48–5.07). CONCLUSION The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection and ICU admission for early preterm births requiring cesarean delivery.

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Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries

Cited by 25 publications

References 9 publications

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Maternal outcomes associated with early preterm cesarean delivery

Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

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