[The risks for fetus and mother depending on the type of cesarean section]

The author points out the tendency to the increasing frequency of cesarean section (mainly) in the interest of the fetus and mother and emphasizes that in some cases the cesarean section itself represents a risk factor. This factor evolves from the direction and place of the uterine incision--transverse and longitudinal. The isthmic transverse incision of the uterine wall, proposed by Kehrer in 1981, is not always the most suitable, since in could not always assure sufficient space for elegant extraction of the fetus. This remark is referred especially to cases, when cesarean section is performed for a fetus under 32 weeks' gestation and then the lower uterine segment is not dilated enough and the transverse isthmic orifice is small for atraumatic extraction of the fetus. For these and some other states--twin pregnancy, transverse oblique presentation of the fetus, placenta previa varicose vessels of both sides of the uterus and very large fetus, the author proposes low isthmic longitudinal hysterectomy and emphasizes the motives for decision making. Except for advantages for the fetus and mother he points out more perfect adaptation of the edges--a guarantee for healthy and elastic edge, in which dehiscences are observed more rarely during the following deliveries according to foreign authors). The experience of the author in low isthmic longitudinal incision of the uterus is made on 62 cesarean sections, performed by 13 obstetricians, all convinced that this incision creates greater space possibilities--conditions for atraumatic extraction of the fetus.