Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery

Soha S. Patel; Nathanael C. Koelper; Sindhu K. Srinivas; Mary D. Sammel; Lisa D. Levine

doi:10.1055/s-0038-1676827

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(08): 785-789
DOI: 10.1055/s-0038-1676827

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery

Authors

Soha S. Patel

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Nathanael C. Koelper

²Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sindhu K. Srinivas

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Mary D. Sammel

³Division of Biostatistics, Epidemiology, and Informatics, Department of Obstetrics and Gynecology, Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Lisa D. Levine

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

Abstract

Objective We sought to compare adverse maternal outcomes between women with and without a uterine extension at the time of cesarean.

Study Design We conducted a retrospective cohort study of women with and without a uterine extension during a primary low transverse cesarean of a full-term singleton gestation. The primary outcomes were (1) estimated blood loss (EBL) and (2) composite maternal morbidity (defined as ≥ 1 of the following: blood transfusion, endometritis, or readmission). Pearson's chi-square or Fisher's exact test was used to compare categorical data; Student's t-test or Mann–Whitney's U-tests was used for continuous data. Linear and logistic regressions were used to adjust for confounding factors.

Results There were 252 women included (126 with extension and 126 without an extension). Women with extensions had a higher EBL (1,038 vs. 832 mL, p < 0.001) and higher rate of the composite maternal morbidity (19.1 vs. 5.6%, p = 0.001). Additionally, women with extensions had an increased risk of postpartum hemorrhage ≥ 1 L (53.2 vs. 23.8%, p < 0.001) and 1.5 L (12.7 vs. 0%, p < 0.001) and were associated with prolonged length of hospital stay (29 vs. 17%, p = 0.04).

Conclusion Uterine extensions are associated with adverse maternal outcomes including higher EBL and increase in maternal morbidity.

Keywords

blood transfusion - cesarean delivery - extension - maternal morbidity - postpartum hemorrhage

Full Text

References

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