Cephalo-caudal V transverse expansion during caesarean section: Systematic review

Caesarean section is the most common surgical operation worldwide. Haemorrhage is the most common complication of this procedure. One of the methods to decrease blood loss is the blunt expansion of the caesarean incision whenever needed. The aim of this review is to compare the evidence for cephalo-caudal versus transverse expansion during caesarean section.
Medline, Scopus, ClinicalTrials.Gov, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar database were searched for eligible clinical trials with no language restrictions.
6 clinical trials were included published between 2008 and 2019. There was a moderate risk of bias due to absence of allocation concealment in most of the trials. Cephalic-caudal expansion less associated with unintended incision extension (RR 0.62; 95%CI 0.45 - 0.86), less uterine artery injury (RR 0.55; 95%CI 0.41 - 0.73), less need for additional suture placement (RR 0.62; 95%CI 0.31 - 4.12) and less transfusion rates (RR 0.75; 95%CI 0.28 - 2.03).
Thus, this review found that cephalic-caudal expansion is far safer than transverse expansion. Accordingly, this review supports the use of cephalic- caudal expansion whenever needed during caesarean section.