gynecology and obstetrics
Cesarean Delivery
Technique
During cesarean delivery, practitioners skilled in Neonatal Resuscitation should be readily available. The uterine incision can be classical or lower segment. Classical:The incision is made vertically in the anterior wall of the uterus, ascending to the upper uterine segment or fundus. This incision typically results in more blood loss than a lower-segment incision and is usually done only when placenta previa is present, fetal position is transverse with the back down, the fetus is preterm, the lower uterine segment is poorly developed, or a fetal anomaly is present. Lower segment:Lower-segment incisions are done most often. A low transverse incision is made in the thinned, elongated lower portion of the uterine body, and the bladder reflection is dissected off the uterus. A vertical lower-segment incision is used only for certain abnormal presentations and for excessively large fetuses. In such cases, a transverse incision is not used because it can extend laterally into the uterine arteries, sometimes causing excessive blood loss. Women who have had deliveries by a low transverse uterine incision are advised about the safety of a trial of labor in subsequent pregnancies. 