Cesarean section

Last revised by Dr Calum Worsley on 01 Nov 2021

Cesarean section (also known as C-section, CS and C/S) is the most frequently done major abdominal surgery in females, performed to deliver a baby as an alternative to normal vaginal delivery 1

Surgical technique

Many forms of cesarean section have been described, but the most popular variation is the low transverse approach following a Pfannenstiel or Joel-Cohen skin entry. Following sharp skin opening, blunt dissection down to the fascia is performed. After which, a transverse incision of the fascial layer is done, with a subsequent blunt division of the rectus abdominis muscles and then careful access into the peritoneal cavity. This is to reduce the risk of accidental iatrogenic trauma to the proximate organs e.g. bowel, bladder, etc. This dissection is considerably more difficult if pre-existing adhesions are present.

Before entry into the uterus, the surgeon assesses the fetal lie, then makes a short low transverse cut through the myometrium in the lower uterine segment, so these procedures are often referred to as a " lower segment cesarean section". Occasionally a vertical incision is performed instead, a so-called “classical cesarean incision". The baby is delivered using extrinsic uterine pressure, with the attached placenta following.

After delivery, the myometrium is repaired using a single or double suture layer. Next the fascial and skin layers are closed. Peritoneum may or may not be closed, but the abdominal wall muscles are usually left divided 1.



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