Types of cesarean section incisions Flashcards
what are the broad subdivisions of c-sections incisions (2)
- skin incision
- uterine incision
what are the types of skin incisions (4)
- pfannenstiel incision (low transverse)
- Joel-cohen incision
- Midline vertical ( classical incision)
- Maylard incision (transverse muscle cutting)
what are the types of uterine incisions(4)
- low transverse incision (Kerr incision)
- low vertical incision (Sellheim incision)
- classical incision (upper segment vertical)
- T shaped, J shaped incision
what is pfannenstiel incision
A horizontal incision made just above the pubic hairline, about 2-3 cm above the symphysis pubis.
what are the advantages of a pfannenstiel incision (30
- Cosmetic: Less visible scar, hidden within the bikini line.
- Stronger healing: Lower risk of wound dehiscence or hernia.
- Less postoperative pain.
what are disadvantages of the pfannenstiel incision (2)
- Longer time to perform and repair.
- Limited exposure: More difficult to extend if needed.
what are the indications for a pfannenstiel incision (2)
- Most common in elective or routine C-sections.
- Preferred for its cosmetic outcome and reduced postoperative pain.
what is a joel-cohen incision
A straight transverse incision, slightly higher than the Pfannenstiel, about 3 cm below the level of the anterior superior iliac spines.
what are advantages of the joel-cohen (3)
- Faster to perform: Less tissue dissection required.
- Less blood loss.
- Reduced risk of adhesions.
what is a disadvantage of a joel-cohen
Scar is slightly more visible than Pfannenstiel.
what are indications for the joel-cohen (2)
- Preferred in some settings for reduced surgical time and blood loss.
- Often used in modern obstetrics where time and reduced complications are prioritized.
what is a kerr incision
A low transverse incision, similar to Pfannenstiel but extending through the lower uterine segment.
what are advantages of a kerr incision (2)
- Less bleeding compared to vertical incisions.
- Easier to repair with less risk of uterine rupture in future pregnancies.
what are disadvantages of kerr incisions (2)
- Limited exposure compared to vertical incisions.
- Not ideal if significant uterine extension is required.
what are indications of kerr incision
Standard in most C-sections, especially when the lower uterine segment is accessible.
what is a midline vertical (classical) incision
A vertical skin incision made from just below the umbilicus to above the symphysis pubis.
what are advantages of a classical skin incision (3)
- Excellent exposure: Allows for rapid entry into the abdominal cavity.
- Useful in emergency situations.
- Better access to the upper segment of the uterus.
what are disadvantages of a classical skin incision (3)
- Increased risk of wound complications and hernia.
- Higher risk of uterine rupture in subsequent pregnancies.
- More postoperative pain and a less cosmetically appealing scar.
what is a sellheim incision
A vertical incision through the lower uterine segment.
what are advantages of the sellheim incision (20
- Good exposure to the lower segment.
- Can be extended upward if needed.
what is a disadvantage of sellheim incision
Higher risk of uterine rupture in future pregnancies compared to transverse incisions.
what are indications for the sellheim incision (2)
- Used when the lower uterine segment is not well-formed or accessible (e.g., preterm cesarean).
- Considered when transverse access is not feasible.
what is a maylard incision
A transverse incision similar to the Pfannenstiel but involves cutting through the rectus muscles.
what are advantages of maylard incision (2)
- Provides excellent exposure of the pelvic organs.
- Allows for easier access in patients with previous scarring or other complications.
what are disadvantages of maylard incision (3)
- Increased blood loss.
- More postoperative pain.
- Longer recovery time.
what are indications for maylard incision (2)
- Cases requiring more extensive pelvic access. 9transverse/ breech presentation, uterine anomalies, multiple pregnancies)
- Useful in patients with significant adhesions or previous abdominal surgeries.
what is a classical incision (upper segment vertical)
A vertical incision made in the upper segment of the uterus, typically extending toward the fundus.
what are advantages of the upper segment vertical incision (2)
- Provides excellent exposure and access to the upper uterus and abdominal cavity.
- Useful in situations where a large uterine incision is needed.
what are disadvantages of the upper segment vertical (2)
- Higher risk of uterine rupture in future pregnancies.
- More blood loss and more difficult to repair.
what are indications for an upper segment vertical (9)
- Emergencies requiring rapid access. (fetal distress)
- Situations involving abnormal placental implantation (e.g., placenta previa or accreta).
- Cases where the lower uterine segment is inaccessible (e.g., transverse lie, deeply engaged head).
- poorly formed lower segment (extreme prematurity)
- conjoined twins
- inaccessible lower segment ( dense adhesions, large leiomyoma)
- cancer of the cervix
- Previous vertical uterine scars.
- Obesity or other anatomical causes