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. 2020 Feb 6;6(Suppl 2):S98-S103.
doi: 10.1055/s-0039-3402072. eCollection 2020 Jul.

Classical Cesarean Section

Amano Kan  1
Affiliations

Classical Cesarean Section

Amano Kan. Surg J (N Y). .

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.

Keywords: cesarean section; classical cesarean section; uterine rupture; vertical uterine incision.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Variety of incisions for hysterotomy. ( A ) Low transverse. ( B ) Low vertical. ( C ) Low transverse with T-extension in the midline. ( D ) Low transverse with J-extension. ( E ) Low transverse with U-extension. ( F ) High transverse. ( G ) Fundal transverse. ( H ) Midline vertical (classical incision). (Reproduced with permission of Amano K. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S, eds. Mastering the Essential Surgical Procedures OGS NOW, No.3. Cesarean Section. (Japanese). Tokyo: Medical View; 2010:42–47. Copyright © Medical View).
Fig. 2
Fig. 2
Closure of the first layer. Text A: Closing the first layer by intermittent sutures includes the deep myometrial edge with minimal decidua. (Reproduced with permission of Amano K. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S, eds. Mastering the Essential Surgical Procedures OGS NOW, No.3. Cesarean Section. (Japanese). Tokyo: Medical View; 2010:42–47. Copyright © Medical View).
Fig. 3
Fig. 3
Closure of the second layer. Text B: The second layer completes the myometrial approximation and hemostasis. The dead space needs to be obliterated. (Reproduced with permission of Amano K. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S, eds. Mastering the Essential Surgical Procedures OGS NOW, No.3. Cesarean Section. (Japanese). Tokyo: Medical View; 2010:42–47. Copyright © Medical View).
Fig. 4
Fig. 4
Closure of the third layer. ( A ) Z suture. ( B ) Continuous suture, figure-of-eight suture. (Reproduced with permission of Amano K. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S, eds. Mastering the Essential Surgical Procedures OGS NOW, No.3. Cesarean Section. (Japanese). Tokyo: Medical View; 2010:42–47. Copyright © Medical View).
See this image and copyright information in PMC

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