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Classical Cesarean Section.

Amano Kan1

  • 1Department of Obstetrics and Gynecology, Center for Perinatal Medicine, Kitasato University School of Medicine, Yoshida Obstetrics and Gynecology Clinic, Tokyo, Japan.

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|August 8, 2020
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Summary
This summary is machine-generated.

Classical cesarean section, a vertical uterine incision, offers fetal access but poses closure challenges. Prior classical cesarean sections contraindicate future labor trials due to uterine rupture risks.

Keywords:
cesarean sectionclassical cesarean sectionuterine rupturevertical uterine incision

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Techniques
  • Maternal-Fetal Medicine

Background:

  • Cesarean section is the most common obstetric surgery.
  • Low transverse hysterotomy is generally preferred.
  • Vertical hysterotomy (classical cesarean section) is reserved for specific challenging scenarios.

Purpose of the Study:

  • To review the indications and implications of classical cesarean section.
  • To highlight the technical difficulties and risks associated with vertical hysterotomy.
  • To emphasize contraindications for subsequent trial of labor after classical cesarean section.

Main Methods:

  • Review of obstetric surgical techniques.
  • Analysis of risks associated with different hysterotomy types.
  • Evaluation of outcomes for subsequent pregnancies.

Main Results:

  • Vertical hysterotomy facilitates fetal delivery in difficult access cases (e.g., preterm labor, placenta accreta).
  • Uterine closure after vertical hysterotomy is technically demanding, increasing hemorrhage and adhesion risks.
  • Prior classical cesarean section is a significant risk factor for uterine rupture, contraindicating trial of labor.

Conclusions:

  • Classical cesarean section, while sometimes necessary, requires meticulous surgical technique for closure.
  • The risk of uterine rupture in subsequent pregnancies necessitates careful consideration and contraindication for trial of labor after a prior classical cesarean section.