Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries

Objective: To compare the uterine incision-to-delivery interval and neonatal and maternal complications in vertical versus transverse uterine incisions in preterm cesarean births. Methods: This is a retrospective cohort study of singleton cesarean deliveries from 2002 to 2009 between 23 and 34 weeks of gestation. Statistical analysis utilized Wilcoxon rank-sum test and multivariable logistic regression. Results: Of the 773 singleton cesarean deliveries, 586 (75.8%) had a transverse uterine incision and 187 (24.2%) had vertical uterine incision (classical=134 and low vertical incision=53). After adjusting for confounders, there was no significant difference in incision-to-delivery interval between the two types of incisions. The risk for maternal transfusion was higher among those with a vertical incision (odds ratio: 2.17; 95% confidence interval: 1.00, 4.67) than those with a transverse incision. Incision type was not associated with any neonatal outcomes studied, including intraventricular hemorrhage, Apgar scores and neonatal mortality. Conclusion: We observed no difference in Uterine Incision-to-Delivery interval and neonatal complications between vertical and transverse incision. Performance of a vertical uterine incision for the sole reason of facilitating a more rapid delivery is not justified. Development of methods to better determine transverse incision feasibility may facilitate a decrease in vertical uterine incisions.