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4.5.1 Risk factors and prevention for extension of uterine incisions

Risk factors

  • Arrest of the first or second stage
  • Fetal malposition (e.g. OP, asynclitic)
  • Macrosomia
  • Failed forceps or vacuum delivery
  • Chorioamnionitis
  • Abnormal fetal heart rate
  • Prematurity
  • Factors cluster into the following categories of risk factors for lateral extension of a transverse uterine incision:
    • Difficulty of extraction
    • Urgency of delivery
    • Poorly developed lower segment

Prevention

  • In cases predisposed to an “inadequate” lower segment, the best prevention is to avoid making a transverse lower segment incision. It is much safer to make a lower segment, vertical incision that can be extended into the upper segment if necessary.
  • In the case of second stage arrest cesarean sections, consider moving your incision site 2 fingerbreadths cephalad.
  • To expand an incision, do so bluntly in a cephalocaudal direction, or extend in the midline making an inverted T incision.
  • With a narrower lower segment, use bandage scissors.
Updated on June 28, 2021

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