Higher Incision at Upper Part of Lower Segment Caesarean Section

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Maternal Health

Background:

• The traditional lower uterine segment incision for cesarean delivery is well-established.
• However, alternative incision sites are being explored to optimize surgical outcomes.
• This study investigates the efficacy of a high uterine incision in the upper part of the lower uterine segment.

Purpose of the Study:

• To compare the safety and efficacy of a transverse incision at the upper part of the lower uterine segment versus the traditional lower segment for cesarean sections.
• To evaluate intraoperative bleeding, operative time, and potential complications associated with each incision site.

Main Methods:

• A case-control study (1:1 ratio) involving 400 cesarean sections (200 high incision, 200 traditional incision) conducted over one year.
• Incision placement was standardized: upper part of the lower segment (2-3 cm from vesico-uterine serosa) versus traditional lower segment.
• Data collected included estimated blood loss, operation duration, and uterine incision integrity.

Main Results:

• The high incision group exhibited significantly less blood loss (188±60.1 ml) compared to the traditional group (330.1±86.5 ml) (p<0.05).
• Operation time was significantly shorter for the high incision (30.5±6.6 min) versus the traditional incision (45.3±7.2 min).
• Tearing of the uterine incision was significantly reduced with the high incision technique.

Conclusions:

• Incision at the upper part of the lower uterine segment offers significant advantages over the traditional site.
• Benefits include reduced blood loss, enhanced uterine retraction, fewer complications, and easier repair.
• This technique also precludes bladder adhesion to the suture line and decreases overall operation time.