CC BY-NC-ND 4.0 · Surg J (N Y) 2020; 06(S 02): S98-S103
DOI: 10.1055/s-0039-3402072
Precision Surgery in Obstetrics and Gynecology
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Classical Cesarean Section

Amano Kan
1   Department of Obstetrics and Gynecology, Center for Perinatal Medicine, Kitasato University School of Medicine, Yoshida Obstetrics and Gynecology Clinic, Tokyo, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
06. Februar 2020 (online)

Abstract

Cesarean section is the most common surgery in obstetrics. Several techniques are proposed according to the indication and the degree of urgency. Usually laparotomy followed by hysterotomy with a low transverse incision is preferable. However, in cases in which it is difficult to access the lower uterine segment, such as that in preterm labor, dense adhesion, placenta previa/accrete a vertical hysterotomy (classical cesarean section) may be needed. Although a smooth and gentle delivery of the fetus is possible through the vertical incision, uterine closure is technically difficult. To decrease the risks of hemorrhage and adhesion, a speedy and skillful technique is mandatory. The most serious risk of vertical incision in the contractile corpus is uterine rupture in the subsequent pregnancy. Therefore, cases of prior classical cesarean section are contraindicated for trial of labor after cesarean section.

 
  • References

  • 1 Luthra G, Gawade P, Starikov R, Markenson G. Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries. J Matern Fetal Neonatal Med 2013; 26 (18) 1788-1791
  • 2 Patterson LS, O'Connell CM, Baskett TF. Maternal and perinatal morbidity associated with classic and inverted T cesarean incisions. Obstet Gynecol 2002; 100 (04) 633-637
  • 3 American College of Obstetricians and Gynecologists. ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Number 5, July 1999 (replaces practice bulletin number 2, October 1998). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet 1999; 66 (02) 197-204
  • 4 Shipp TD, Zelop CM, Repke JT, Cohen A, Caughey AB, Lieberman E. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol 1999; 94 (5 Pt 1): 735-740
  • 5 Halperin ME, Moore DC, Hannah WJ. Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies. Br J Obstet Gynaecol 1988; 95 (10) 990-996
  • 6 Moramarco V, Korale Liyanage S, Ninan K, Mukerji A, McDonald SD. Classical caesarean: what are the maternal and infant risks compared with low transverse caesarean in preterm birth, and subsequent uterine rupture risk? A systematic review and meta-analysis. J Obstet Gynaecol Can 2019; S1701-2163(19)30090-8
  • 7 Scott JR. Avoiding labor problems during vaginal birth after cesarean delivery. Clin Obstet Gynecol 1997; 40 (03) 533-541
  • 8 Gyamfi-Bannerman C, Gilbert S, Landon MB. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol 2012; 120 (06) 1332-1337
  • 9 Chauhan SP, Magann EF, Wiggs CD, Barrilleaux PS, Martin Jr JN. Pregnancy after classic cesarean delivery. Obstet Gynecol 2002; 100 (5 Pt 1): 946-950
  • 10 Stotland NE, Lipschitz LS, Caughey AB. Delivery strategies for women with a previous classic cesarean delivery: a decision analysis. Am J Obstet Gynecol 2002; 187 (05) 1203-1208
  • 11 Landon MB, Lynch CD. Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data. Semin Perinatol 2011; 35 (05) 257-261
  • 12 Bakhshi T, Landon MB, Lai Y. , et al. Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision. Am J Perinatol 2010; 27 (10) 791-796