Do Unintended Uterine Extensions Increase Rupture?

From Dr. Chapa’s OBGYN Clinical Pearls Dr. Chapa’s Clinical Pearls

Uterine hysterotomy unintended extensions happen. For sure. This has been analyzed over many years, and it is still making news. Look at this mini-timeline: Back in 2018, authors published “Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity”. Moving up the timeline to 2020, others published in J Maternal-Fetal Neonatal Medicine, “Risk factors for uterine incision extension during cesarean delivery”. Then in 2024, in the PINK journal, authors published a related study, “The association between unintended hysterotomy extensions with cesarean delivery and subsequent preterm birth”. In this episode, we will review a new narrative review (in the Green Journal, May 3, 2026) of unintended hysterotomy extension at C-section. We will summarize known risk factors and focus on subsequent uterine rupture risk. Does unintended hysterotomy extension at CS increase TOLAC uterine rupture? It’s complicated. Listen in for details.

1. Giugale LE, Sakamoto S, Yabes J, Dunn SL, Krans EE. Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity. J Obstet Gynaecol. 2018 Nov;38(8):1048-1053.

2. Epub: Unintentional Extensions of the Cesarean Hysterotomy Incision. A Review and Proposed Classification System (May 3, 2026)