Does craniocaudal extension of the hysterotomy reduce intraoperative complications compared with transverse extension in the case of emergency caesarean section?

Introduction The main objective was to study the occurrence of intraoperative complications after emergency caesarean section during labor according to the type of hysterotomy extension performed. Material and Methods This was a single‐center comparative study of hysterotomy extension by transverse traction (January 2015 to April 2017) versus cephalocaudal traction (May 2021 to February 2022). All women who underwent an emergency caesarean section (orange or red code) during these two periods were included. The primary endpoint was a composite of the occurrence of unintended extension, uterine pedicle injury, postpartum hemorrhage >1 L, and the blood product transfusion. Results The study included 767 patients. At least one intraoperative complication occurred in 122 women (21.4%) in the transverse traction group and in 33 (16.8%) women in the cephalocaudal traction group (OR 0.74, 95% CI [0.48–1.13]; p = 0.16). The incidence of these complications did not differ between groups after weighting (adjusted OR 0.78, 95% CI [0.52–1.19]; adjusted p = 0.25). Individual analysis of each component of the composite endpoint also showed no differences between groups. Conclusions In this study of emergency caesarean sections, the type of hysterotomy extension did not significantly influence the rate or type of intraoperative complications.