Classical versus low‐segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies

Abstract

Summary. In a retrospective, controlled, follow‐up study of 326 women who had a primary preterm caesarean section, the risks of postoperative maternal morbidity and uterine rupture or dehiscence in subsequent pregnancies were investigated in relation to the mode of incision (classical compared with low‐segment transverse incision). The classical incision was associated with a higher frequency of postpartum fever in the immediate postoperative period (16% compared with 6%, P<0·01). Of the 326 patients reviewed 286 (88%) were contacted for information about subsequent pregnancies. Information was obtained for 70 pregnancies subsequent to a classical caesarean section, and 71 pregnancies subsequent to a low‐segment transverse caesarean section, which had continued for more than 20 weeks gestation. Of the pregnancies after the classical operation 13% had abnormal scars compared with none of those after the low‐segment transverse operation (P=0·0014). The frequency of scar dehiscence was 6% after a classical scar compared with none after a low‐segment transverse scar (P=0·0581).

Uterine incision and maternal blood loss in preterm caesarean section

“…However there is both a well documented increase in scar rupture in subsequent pregnancies and an increase in immediate postoperative morbidity with classical compared to lower segment caesarean section (Dewhurst 1956, Morley 1961, Halperin et al 1988. Although febrile morbidity has been well studied (Halperin et al 1988), comparisons between perioperative blood loss is not readily available because it is difficult to estimate (Harley 1980), especially in preterm caesarean sections which are invariably emergencies. A recent T.T.…”

Placenta Percreta Leading to Spontaneous Complete Uterine Rupture in the Second Trimester

“…Lower-segment transverse incision is generally considered to have a significantly lower risk for uterine rupture than classical corporal incision [6] , but this case highlights that in rare cases scar dehiscence after lower-segment incision can occur.…”

Timing of Elective Cesarean Delivery at Term

“…Patients with prior classical hysterotomies have been reported to have an even higher incidence of uterine rupture. Rupture has been reported to occur in many of these women even before the onset of labor (Halperin et al, 1988). Although the incidence of uterine rupture mentioned above has been reported to occur among women after a trial of labor, still, it's not rare to encounter women assigned to elective cesarean delivery, to present in advance stages of labor.…”