{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:50:53Z","timestamp":1777625453243,"version":"3.51.4"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to determine if the rate of hysterotomy extensions increases with increasing cervical dilation in unscheduled cesarean deliveries, and to develop a measure of the severity of hysterotomy extension for quantifying morbidity.<\/jats:p>\n                  <jats:p>This is a retrospective study of unscheduled cesarean deliveries relating to labor dystocia and\/or nonreassuring tracings from January 1, 2021, to December 31, 2021. Severe extension was defined as bilateral or adjacent to a structure such as the uterine artery, broad ligament, or cervix, and was compared with uterine artery extensions alone.<\/jats:p>\n                  <jats:p>There were 990 unscheduled cesarean deliveries included. Extensions (n\u2009=\u2009233) significantly increased with increasing cervical dilation (p\u2009&lt;\u20090.0001), complicating more than 30 and 50% at 6 and 10\u2009cm of cervical dilation, respectively. Apart from this trend, a logistic regression analysis indicated cervical dilation was an independent risk factor for extension. Transfusions of at least 2 units of blood were five times (26 vs. 5%) more likely for patients with severe extensions than no extension (p\u2009&lt;\u20090.0001).<\/jats:p>\n                  <jats:p>Hysterotomy extensions significantly increase with increasing cervical dilation, and cervical dilation is an independent risk factor for extension. A composite measure of severity accounts for different types of extension when quantifying morbidity, but uterine artery extension is the primary driver of maternal morbidity in cases without hysterectomy.<\/jats:p>","DOI":"10.1055\/a-2586-3568","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T18:59:22Z","timestamp":1746557962000},"page":"023-031","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of Hysterotomy Extension at Unscheduled Cesarean Delivery"],"prefix":"10.1055","volume":"43","author":[{"given":"Jason G.","family":"Bunn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Hospital, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Warncke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Hospital, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saron","family":"Gilazgi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald D.","family":"Mcintire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David B.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Hospital, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine Y.","family":"Spong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Hospital, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Seth","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Hospital, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/AOG.0000000000005447","article-title":"First and second stage labor management: ACOG clinical practice guideline no. 8","volume":"143","author":"ACOG Clinical Practice","year":"2024","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1055\/s-0038-1676112","article-title":"Risk factors and maternal morbidity associated with unintentional hysterotomy extension at the time of cesarean delivery","volume":"36","author":"K H Bligard","year":"2019","journal-title":"Am J 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