Objective: To compare the outcomes of the two techniques of blunt uterine extension. Materials and methods: A randomized controlled trial was conducted from April to July 2022 after the institutional human ethics committee approval. All pregnant women at or beyond term undergoing cesarean were included. Computer-based randomization was generated. A total of 521 patients were screened. As required, 154 patients were recruited and 77 were equally randomized in the cephalad-caudad (CC) and transverse (TS) expansion groups. The primary outcome was the estimation of unintended intraoperative injuries and drop in the hemoglobin (Hb) level (postoperatively). Secondary outcomes were to determine the postoperative complications. Results: Higher number of unintended injuries were noted in the TS expansion compared with CC expansion group, 2 (2.6%) vs 1 (1.3%); p = 1.0, similar to the unintended uterine artery injury [7 (9.1%) vs 6 (7.8%); p = 0.7]; however, both the parameters did not show any statistical difference. A clinically relevant case of significant broad ligament hematoma injury happened in the TS group. Postpartum hemorrhage (PPH) occurred in 4 (5.2%) patients of TS group of which one needed blood transfusion, while none occurred in the CC group. The mean difference in drop of Hb was not significant (TS vs CC, 0.9 ± 1.1 vs 1.0 ± 1.1; p = 0.3). The mean difference of visual analog scale (VAS) scores was not significant (2.8 ± 1.6 vs 2.5 ± 1.6; p = 0.2). There were no case of endometritis, fever, or sepsis. Conclusion: The cephalad-caudad blunt expansion technique is equally safer than the transverse expansion.