Unintended uterine extension at the time of cesarean delivery - risk factors and associated adverse maternal and neonatal outcomes

• Published in: The journal of maternal-fetal & neonatal medicine 2023-12, Vol.36 (1), p.2204997-2204997
• Main Authors: Wilkof-Segev, Renana, Naeh, Amir, Barda, Sivan, Hallak, Mordechai, Gabbay-Benziv, Rinat
• Format: Article
• Language: English
• Subjects: adverse outcome; Cesarean delivery; Cesarean Section; Female; Humans; Infant, Newborn; Postpartum Hemorrhage - etiology; Pregnancy; pregnancy complications; Retrospective Studies; Risk Factors; Trial of Labor; unintended uterine extension
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2023.2204997

To identify risk factors, maternal and neonatal adverse outcomes related to unintended lower segment uterine extension during cesarean delivery (CD). A retrospective cohort analysis in a single, university-affiliated medical center between 1 January 2018 and 31 December 2019. All singleton pregnancies delivered by CD were included. Univariate and multivariate analyses were performed to identify maternal and obstetrical predictors for uterine extension during CD. For secondary outcomes, we assessed the correlation between uterine extension and any adverse maternal or neonatal outcome. Risk factors were analyzed using ROC statistics to measure their prediction performance for a uterine extension. Overall, 1746 (19.3%) CDs were performed during the study period. Of them, 121 (6.9%) CDs were complicated by unintended uterine extension. There was no difference in maternal demographics and clinical data stratified by uterine extension at CD. Uterine extensions were significantly more common following induction of labor, intrapartum fever, premature rupture of membranes, a trial of labor after cesarean, advanced gestational age, emergent CD, and in particular CD during the second stage of labor (37.2% vs. 6.5%) and after failed vacuum extraction (6.6% vs. 1.1%), p