Greater risk of incision rupture during subsequent pregnancies (four times higher with classical incision) If rupture occurs - Bleeding and risk of expulsion of fetus into peritoneal cavity greater than with lower segment caesarean section Lower segment incisions Low transverse uterine incision Used in over 90% of cases Advantages: Easy to repair Reduced adhesion formation Decreased blood loss Low risk of dehiscence or rupture in subsequent pregnancies Disadvantages: Greater chance of lateral extension of the incision into major uterine vessels resulting in maternal morbidity due to haemorrhage in situations where lower uterine segment is poorly developed (prematurity, transverse lie) Incision can be extended into the upper uterine segment as a J or U or inverted T which then have the same risks as classical incision Low vertical uterine incision (De Lee) Used when transverse incision inappropriate: usually if there is an underdeveloped lower segment Avoids risk of unintentional extension of incision into lateral vessels Incision can be extended upwards into the body of the uterus (i.e. classical incision) if more room is needed. This creates the same risks as classical incision Extensive dissection of the bladder is necessary to keep the uterine incision in the lower uterine segment. If incision extends downwards it may tear through the cervix into the vagina and possibly the bladder Preparation Written informed consent. In addition discussing risks and benefits before a transverse lower uterine segment caesarean section, the patient should also be informed about: the increased risk of blood loss and need for blood transfusion (especially if CS done for placenta praevia) increased risk of uterine rupture with subsequent pregnancy and therefore the need for elective caesarean section Left lateral tilt to minimize maternal inferior vena caval compression. This reduces the risk of hypotension and reduction in uteroplacental perfusion Indwelling urinary catheter Shave suprapubic hair as close to time of procedure as possible. This minimises risk of infection in small lacerations Clean skin with antiseptic solution – usually povidine-iodine
Greater risk of incision rupture during subsequent pregnancies (four times higher with classical incision) If rupture occurs - Bleeding and risk of expulsion of fetus into peritoneal cavity greater than with lower segment caesarean section Lower segment incisions Low transverse uterine incision Used in over 90% of cases Advantages: Easy to repair Reduced adhesion formation Decreased blood loss Low risk of dehiscence or rupture in subsequent pregnancies Disadvantages: Greater chance of lateral extension of the incision into major uterine vessels resulting in maternal morbidity due to haemorrhage in situations where lower uterine segment is poorly developed (prematurity, transverse lie) Incision can be extended into the upper uterine segment as a J or U or inverted T which then have the same risks as classical incision Low vertical uterine incision (De Lee) Used when transverse incision inappropriate: usually if there is an underdeveloped lower segment Avoids risk of unintentional extension of incision into lateral vessels Incision can be extended upwards into the body of the uterus (i.e. classical incision) if more room is needed. This creates the same risks as classical incision Extensive dissection of the bladder is necessary to keep the uterine incision in the lower uterine segment. If incision extends downwards it may tear through the cervix into the vagina and possibly the bladder Preparation Written informed consent. In addition discussing risks and benefits before a transverse lower uterine segment caesarean section, the patient should also be informed about: the increased risk of blood loss and need for blood transfusion (especially if CS done for placenta praevia) increased risk of uterine rupture with subsequent pregnancy and therefore the need for elective caesarean section Left lateral tilt to minimize maternal inferior vena caval compression. This reduces the risk of hypotension and reduction in uteroplacental perfusion Indwelling urinary catheter Shave suprapubic hair as close to time of procedure as possible. This minimises risk of infection in small lacerations Clean skin with antiseptic solution – usually povidine-iodine
Procedures%20in%20Obstetrics%20and%20Gynaecology%20Textbook.docx