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Low Vertical Uterine Incision in Caesarean Section
Author(s) -
George Lourdes St,
Kuah K. B.
Publication year - 1987
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1987.tb00922.x
Subject(s) - medicine , caesarean section , breech presentation , obstetrics , cervix , uterine rupture , uterus , fetus , pregnancy , genetics , cancer , biology
EDITORIAL COMMENT : The classical operation is performed in 1–2% of Caesarean sections usually for transverse lie, failure of development of the lower segment (prematurity 5 breech presentation), dense adhesions, large veins over the lower segment (placenta praevia), constriction ring and invasive carcinoma of the cervix. The classical operation is likely to be performed more often than formerly because more very premature infants (26–32 weeks' gestation) are being delivered by Caesarean section — in these pregnancies the lower segment is often poorly formed, especially when there is the combination of fetal growth retardation, oligohydramnios and breech presentation. This paper has 2 important messages: firstly that in only 11 of 3,420 (0.3%) Caesarean sections was a vertical uterine incision necessary; secondly that in all II cases a low vertical uterine incision was possible. Personal preference determines practice in obstetrics. This paper suggests that we should resist the temptation to incise the upper uterine segment and, if a vertical incision is needed, the technique described in this paper warrants consideration. The type of anaesthesia is also important. The problem of a poorly formed lower segment can usually be anticipated — if halothane is employed to relax the uterus, a vertical uterine incision is less likely to be required. Since these operations are performed for fetal indications it is essential that delivery of the fetus is gentle with minimal risk of overmoulding which may result in intracranial haemorrhage. Summary: Eleven of the 3,420 Caesarean sections performed in Westmead Hospital, Sydney during a 6‐year period from 1979 to 1985 were by a low vertical uterine incision. All the others were the standard transverse lower segment operation except for 1 which was a postmortem classical Caesarean section. There are indications when the preferred lower segment Caesarean section with a transverse incision should be avoided in the interest of the mother and baby. A low vertical incision has more advantages and less dangers than a classical fundal incision. It is prudent to defer the decision regarding the type of incision until the uterus is inspected intraoperatively. If access to the lower uterine segment is limited by prematurity, an obstructing lesion, a transverse lie, or if the presenting part is high and difficulty in delivering the baby is anticipated, a low vertical incision should be considered.