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CESAREAN DELIVERY IN THE UNITED STATES . .. ... 567
CESAREAN DELIVERY RISKS ......... . . .... .. 568
PATIENT PREPARATION .... .. . . .. ... ... 569
CESAREAN DELIVERY TECHNIQUE . . . ........... 571
LAPAROTOMY ........ .... . .... ... .. .. 571
HYSTEROTOMY .. ..... .. ... ..... .. . .. . 573
PERIPARTUM HYSTERECTOMY ... ......... ...... 580
POSTOPERATIVE CARE . . . . . . . . . . . . . . . . . . . . . . . . . 585 ?he anterior suace of the uterus is opened longitudinaly along its midline. ?his is best accomplished by making an incision a ew centimetres long with a scapel, and then rapidy enlarging it with the scissors to 16 or 18 centimetres. ?he membranes are then rupture, the child is seized by one oot and rapidy extracted -]. Whitridge Williams (1903)
From the above description, cesarean technique has evolved during the past century. For example, preference for classical hysterotomy has given way to low transverse incision. Evidence-based data now guide many surgical steps and are presented throughout this chapter.
Of deinitions, cesarean delivey defines the birth of a fetus via laparotomy and then hysterotomy. This definition is not applied to removal of the fetus from the abdominal cavity in the case of uterine rupture or with abdominal pregnancy. Rarely, hysterotomy is performed in a woman who has just died or in whom death is expected soon-postmortem orperimortem cesarean delivery (Chap. 47, p. 931).