Background: The most common major surgical procedure in obstetrics and gynecology in Cesarean Section (CS). Though advances in CS techniques, antibiotics, blood transfusion etc., have improved maternal and fetal outcomes. Cesarean delivery still poses higher maternal morbidity and mortality than vaginal delivery. One of the major causes of morbidity and mortality in CS is intra-operative hemorrhage which is partly caused by uterine incision extension (IE).
Objective: To determine the prevalence of uterine IE and assess factors associated with IE in CSs in three teaching hospitals in Addis Ababa, Ethiopia.
Methods: A cross-sectional study was undertaken from July 1 to August 30,2005 at three teaching hospital of Addis Ababa University. The data was entered and analyzed using EPI INFO statistical package, version 6.
Main Results: There were 42(12.7%) IEs among the 332 CS. Second state of labor (n=14, 34.1%), low station (m=16, 30.7%), occipito-posterior position (n=15, 25.4%), prolonged labor (21, 20.4%), rupture of membrane (n=16, 28.6%), and dystocia (n=86, 25.9%) were found to have significantly higher IE prevalence. Post-partum hemorrhage (PPH) due to tear of a vessel was seen in 33.3% of the IES. Even though the occurrence of IE was more common in those with emergency CS (13.4%), repeat CS (14.5%) and CS before term (16.7%) than elective (7.1%), primary (12.1%), and CS AT TERM (12.3%), respectively, the differences were not statistically significant.
Conclusion: IE is one major cause of intra-operative complications occurring in CS performed in the three teaching hospitals. In the presence of high risk factors (rupture of membranes, second stage of labor and low station of the presenting part), intra-operative complication should be anticipated and appropriate precautions made. Further studies are required to assess the long-term complications and better uterine incision techniques.
Ethiopian Journal of Reproductive Health, 2011, 5(1):31-38