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Abstract：
OBJECTIVE: To evaluate two techniques of uterine incision expansion (cephalad-caudad vs. transverse) during Caesarean section (CS).
METHODS: A total of 839 patients were randomized to either a cephalad-caudad blunt expansion of uterine incision during CS versus a transverse (lateral-lateral) expansion. The primary outcome was blood loss, measured with the descent of hemoglobin level. Secondary outcomes were the need for blood transfusion and the number of surgical or postoperative complications presented in both groups.
RESULTS: There was no statistical difference with regard to decrease in hemoglobin level, but there was a higher number of surgical complications in the transverse expansion group (Cephalad-caudad: 11.53% vs. transverse: 16.42%; odds ratio [OR] 0.66; 95% confidence interval [CI] 0.45-0.98; P = 0.04). There were more cases of unintended extensions of uterine incision (10.35% vs. 16.18%; OR 0.6; 95% CI 0.4-0.9; P = 0.01) but no statistical difference in the number of hematomas, uterine vessel injury, or the need to transfuse.
CONCLUSIONS: The cephalad-caudad blunt expansion technique of the low transverse uterine incision is safer than the transverse expansion. There was no difference in regard to decrease in hemoglobin level, but there is a lower risk of surgical complications not associated with an increased need for blood transfusions when compared with the transverse expansion.
METHODS: A total of 839 patients were randomized to either a cephalad-caudad blunt expansion of uterine incision during CS versus a transverse (lateral-lateral) expansion. The primary outcome was blood loss, measured with the descent of hemoglobin level. Secondary outcomes were the need for blood transfusion and the number of surgical or postoperative complications presented in both groups.
RESULTS: There was no statistical difference with regard to decrease in hemoglobin level, but there was a higher number of surgical complications in the transverse expansion group (Cephalad-caudad: 11.53% vs. transverse: 16.42%; odds ratio [OR] 0.66; 95% confidence interval [CI] 0.45-0.98; P = 0.04). There were more cases of unintended extensions of uterine incision (10.35% vs. 16.18%; OR 0.6; 95% CI 0.4-0.9; P = 0.01) but no statistical difference in the number of hematomas, uterine vessel injury, or the need to transfuse.
CONCLUSIONS: The cephalad-caudad blunt expansion technique of the low transverse uterine incision is safer than the transverse expansion. There was no difference in regard to decrease in hemoglobin level, but there is a lower risk of surgical complications not associated with an increased need for blood transfusions when compared with the transverse expansion.
摘要：
目的：评估两种子宫切口扩大技术（头尾与横切）在剖腹产（CS）期间。
方法：共有839例患者被随机分为CS期间子宫切口的头尾钝性扩张与横向（外侧-外侧）扩张。主要结果是失血,随着血红蛋白水平的下降而测量。次要结果是两组的输血需求和手术或术后并发症的数量。
结果：血红蛋白水平下降没有统计学差异，但横向扩张组中手术并发症的发生率更高(Cephalad-caudad：11.53%vs.横向：16.42%；比值比[OR]0.66；95%置信区间[CI]0.45-0.98；P=0.04）。子宫切口意外延长的病例较多(10.35%vs.16.18%;OR0.6;95%CI0.4-0.9;P=0.01)但血肿数量无统计学差异,子宫血管损伤,或者需要输血。
结论：子宫下横切口头尾钝性扩张技术比横向扩张技术更安全。血红蛋白水平下降没有差异，但与横向扩张相比，手术并发症的风险较低，与输血需求增加无关。
方法：共有839例患者被随机分为CS期间子宫切口的头尾钝性扩张与横向（外侧-外侧）扩张。主要结果是失血,随着血红蛋白水平的下降而测量。次要结果是两组的输血需求和手术或术后并发症的数量。
结果：血红蛋白水平下降没有统计学差异，但横向扩张组中手术并发症的发生率更高(Cephalad-caudad：11.53%vs.横向：16.42%；比值比[OR]0.66；95%置信区间[CI]0.45-0.98；P=0.04）。子宫切口意外延长的病例较多(10.35%vs.16.18%;OR0.6;95%CI0.4-0.9;P=0.01)但血肿数量无统计学差异,子宫血管损伤,或者需要输血。
结论：子宫下横切口头尾钝性扩张技术比横向扩张技术更安全。血红蛋白水平下降没有差异，但与横向扩张相比，手术并发症的风险较低，与输血需求增加无关。
