Blunt vs. sharp uterine expansion at lower segment cesarean section delivery: a systematic review with metaanalysis.

OBJECTIVE: Blunt vs sharp expansion of the uterine incision at cesarean delivery has been investigated as a technique primarily to reduce intraoperative blood loss. The objective of this systematic review was to compare the effects of either intervention on maternal outcomes.

STUDY DESIGN: A systematic review with metaanalyses that used the DerSimonian and Laird random effects model was performed. The Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 4), MEDLINE (1948-Apr 2012), EMBASE (1947-Apr 2012), and the reference lists/citation history of articles were searched. Only randomized controlled trials were included.

RESULTS: Four trials (1731 patients) were evaluated. Data from one recently completed trial (535 patients) were not yet available. Metaanalyses revealed a trend towards reduced maternal blood loss with blunt expansion of the uterine incision that was statistically significant when measured by surgeon's estimation of volume lost, but not by comparison of pre- and postoperative hematocrit and hemoglobin levels or a requirement for blood transfusion. There was a trend towards fewer unintended extensions in the blunt group and no difference in the incidence of endometritis.

CONCLUSION: Blunt dissection of the uterine incision at cesarean delivery appears to be superior to sharp dissection in minimizing maternal blood loss. However, this conclusion could change when data from a new unpublished large trial are available.