Uterine extensions occur in <10% of cesarean deliveries, with extensions into the broad ligament being the least common. The highest rate of extensions at the time of a cesarean delivery are during the second stage of labor, ranging from 14 to 26%. If pushing lasts for >4 hours, that rate increases to 40%. These patients have a higher rate of postpartum hemorrhage, but there are no other risk factors clearly identified in the literature. Therefore, prevention of extensions is critical. This can be accomplished with a uterine incision that is expanded with a blunt, cephalad-caudad technique, as well as by using several evidence-based methods as detailed in Case 53. Visualization is key during management, and for this you may need additional help. Small, stable broad ligament hematomas can be monitored, whereas an expanding hematoma is an obstetric emergency, requiring pressure or rapid surgical management. If a hematoma expands despite an O’Leary stitch and uterotonics, IR consultation for embolization is a first-line intervention. If unavailable, it may be necessary to evacuate the hematoma and attempt to isolate the bleeding vessels for ligation. If the patient is unstable or the hematoma continues to expand, consider internal iliac artery/hypogastric artery ligation and/or hysterectomy. Finally, cystoscopy is necessary if the extension is near the ureter or the bladder.