Uterine incision and maternal blood loss in preterm caesarean section

Abstract

The purpose of this study was to compare maternal blood loss, as reflected by the perioperative changes in haemoglobin (Hgb), the incidence of severe bleeding (estimated blood loss > 1000 ml) at operation, and the need for blood transfusion, between patients who had classical caesarean section (CCS) and lower segment caesarean section (LSCS) at 34 weeks gestation or less. The data from 31 women delivered by CSS between 25 and 34 weeks gestation were compared, in a retrospective case-control fashion, to another 31 women delivered by LSCS. Patients were matched for gestational age at delivery, the type of anaesthesia, and the prior use of tocolytic therapy. Excluded from the study were patients who had an antepartum haemorrhage or placenta praevia. There was a significantly greater reduction in maternal Hgb and an higher incidence of severe bleeding in the CSS group compared to the LSCS group (P < 0.05). The results of this study suggest that for preterm caesarean sections, the classical incision is associated with increased blood loss compared to the lower segment incision.

Early onset, severe fetal growth restriction with absent or reversed end‐diastolic flow velocity waveform in the umbilical artery: Perinatal and long‐term outcomes

“…The likelihood of classical CS has been shown to be greater at earlier gestations. 22 Though no higher short-term morbidity was demonstrated in this study, classical CS has been associated with increased immediate maternal morbidity from infection and haemorrhage, [23][24][25] and subsequent pregnancies having increased rates of uterine scar complications. 26 Our study confirms a high perinatal mortality rate in pregnancies requiring delivery by classical CS.…”

“…At presentation, the median gestational age and EFW were 24 (range, [18][19][20][21][22][23][24][25][26][27][28][29] weeks and 364 (range, 167-496) g, respectively. Absent end-diastolic flow was present in 24 cases (67%) and reversed end-diastolic flow in 12 (33%).…”

Maternal outcomes associated with early preterm cesarean delivery

“…Prior studies have found increased risks of postpartum hemorrhage and blood transfusion in women undergoing classical cesarean delivery, 6, 7, 9, 10 although other studies did not find an increased risk. 4, 8 This conflicting data might be due to different inclusion criteria (term versus preterm).…”

Cesarean delivery

“…The transverse incision in the lower uterine segment is usually recommended (1). Some experts advocate the classical vertical or at least low vertical incision if the lower uterine segment is not large enough to allow a transverse incision, for example, for the very preterm (<28 weeks) uterus, and fibroids, but this has been associated with increased blood loss compared with low transverse incision (41).…”