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

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 >= 1L (53.2 vs. 23.8%, p <0.001) and 1.5L (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.