Higher Incision at Upper Part of Lower Segment Caesarean Section
Introduction: To determine if the upper part of the lower segment of the uterus is a better site for cesarean incision then the traditionally used lower end.
Methods: This is a case-control study (1:1 ratio) conducted from 1st October 2012– 30th September 2013 observed between transverse incision at the upper part of the lower segment versus traditional lower segment of the uterus. Two hundred caesarean sections were performed via a transverse uterine incision at the upper part of the lower segment and equal numbers of uterine incision was performed at traditional lower segment. To obtain less intraoperative bleeding high incision made at thicker wider muscular part at of the upper part of lower segment about 2-3 cm distances from vesico-uterine serosa.
Results: The estimated volume of blood loss in high incision 188±60.1 ml was significantly less compared to traditional incision 330.1± 86.5 ml (p<0.05). Duration of operation 30.5± 6.6 minute versus 45.3±7.2 minute and tearing the uterine incision was significantly less with the high incision versus traditional incision. Other procedural and patient benefits are noted.
Conclusions: An incision at the upper part of the lower segment reduces blood loss, enhances uterine retraction, predisposes to fewer complications, is easier to repair, precludes bladder adhesion to the suture line and reduces operation time.
Keywords: caesarean section; higher incision technique; traditional uterine incision technique.
10. Zhu MK, Yin DY. Measurement of blood loss during normal delivery and 24 hours postpartum. Hong Hua Hi Li Za Zhi. 1985;20:10-2. 11. Feng XL, Xu L, Guo Y, Ronsamans C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ. 2012;90:30-9A . 12. Zhou YY, Zhu J, Wang YP, Dai L, Li XH, Li MR, et al. Trends of maternal mortality ratio during 1996-2010 in China. Zhonghua Yu Fang Yi Xue Za Zhi. 2011;45:934-9. 13. Center for Disease control and prevention, National center for health statistics, National vital statistic report. Vol52, no.10, 2003. 14. Williams JW. A critical analysis of 21 years’ experience with cesarean section. Bull Johns Hopkins Hos. 1921;32:173. 15. Schwarz O, Paddock R, Bortnick AR. The cesarean section scar: An experimental study. Am J Obstet Gynecol. 1938;36:962. 16. Tinelli A, Malvasi A, Vittori G. Laparoscopic treatment of post-cesarean section bladder flap hematoma: A feasible and safe approach. Minim Invasiv Ther Allied Technol. 2009;18:356-60.
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