Types of cesarean section incisions

Question 1

what are the broad subdivisions of c-sections incisions (2)

Answer 1

• skin incision
• uterine incision

Question 2

what are the types of skin incisions (4)

Answer 2

1. pfannenstiel incision (low transverse)
2. Joel-cohen incision
3. Midline vertical ( classical incision)
4. Maylard incision (transverse muscle cutting)

Question 3

what are the types of uterine incisions(4)

Answer 3

1. low transverse incision (Kerr incision)
2. low vertical incision (Sellheim incision)
3. classical incision (upper segment vertical)
4. T shaped, J shaped incision

Question 4

what is pfannenstiel incision

Answer 4

A horizontal incision made just above the pubic hairline, about 2-3 cm above the symphysis pubis.

Question 5

what are the advantages of a pfannenstiel incision (30

Answer 5

• Cosmetic: Less visible scar, hidden within the bikini line.
• Stronger healing: Lower risk of wound dehiscence or hernia.
• Less postoperative pain.

Question 6

what are disadvantages of the pfannenstiel incision (2)

Answer 6

• Longer time to perform and repair.
• Limited exposure: More difficult to extend if needed.

Question 7

what are the indications for a pfannenstiel incision (2)

Answer 7

• Most common in elective or routine C-sections.
• Preferred for its cosmetic outcome and reduced postoperative pain.

Question 8

what is a joel-cohen incision

Answer 8

A straight transverse incision, slightly higher than the Pfannenstiel, about 3 cm below the level of the anterior superior iliac spines.

Question 9

what are advantages of the joel-cohen (3)

Answer 9

• Faster to perform: Less tissue dissection required.
• Less blood loss.
• Reduced risk of adhesions.

Question 10

what is a disadvantage of a joel-cohen

Answer 10

Scar is slightly more visible than Pfannenstiel.

Question 11

what are indications for the joel-cohen (2)

Answer 11

• Preferred in some settings for reduced surgical time and blood loss.
• Often used in modern obstetrics where time and reduced complications are prioritized.

Question 12

what is a kerr incision

Answer 12

A low transverse incision, similar to Pfannenstiel but extending through the lower uterine segment.

Question 13

what are advantages of a kerr incision (2)

Answer 13

• Less bleeding compared to vertical incisions.
• Easier to repair with less risk of uterine rupture in future pregnancies.

Question 14

what are disadvantages of kerr incisions (2)

Answer 14

• Limited exposure compared to vertical incisions.
• Not ideal if significant uterine extension is required.

Question 15

what are indications of kerr incision

Answer 15

Standard in most C-sections, especially when the lower uterine segment is accessible.

Question 16

what is a midline vertical (classical) incision

Answer 16

A vertical skin incision made from just below the umbilicus to above the symphysis pubis.

Question 17

what are advantages of a classical skin incision (3)

Answer 17

• Excellent exposure: Allows for rapid entry into the abdominal cavity.
• Useful in emergency situations.
• Better access to the upper segment of the uterus.

Question 18

what are disadvantages of a classical skin incision (3)

Answer 18

• Increased risk of wound complications and hernia.
• Higher risk of uterine rupture in subsequent pregnancies.
• More postoperative pain and a less cosmetically appealing scar.

Question 19

what is a sellheim incision

Answer 19

A vertical incision through the lower uterine segment.

Question 20

what are advantages of the sellheim incision (20

Answer 20

• Good exposure to the lower segment.
• Can be extended upward if needed.

Question 21

what is a disadvantage of sellheim incision

Answer 21

Higher risk of uterine rupture in future pregnancies compared to transverse incisions.

Question 22

what are indications for the sellheim incision (2)

Answer 22

• Used when the lower uterine segment is not well-formed or accessible (e.g., preterm cesarean).
• Considered when transverse access is not feasible.

Question 23

what is a maylard incision

Answer 23

A transverse incision similar to the Pfannenstiel but involves cutting through the rectus muscles.

Question 24

what are advantages of maylard incision (2)

Answer 24

• Provides excellent exposure of the pelvic organs.
• Allows for easier access in patients with previous scarring or other complications.

Question 25

what are disadvantages of maylard incision (3)

Answer 25

• Increased blood loss.
• More postoperative pain.
• Longer recovery time.

Question 26

what are indications for maylard incision (2)

Answer 26

• Cases requiring more extensive pelvic access. 9transverse/ breech presentation, uterine anomalies, multiple pregnancies)
• Useful in patients with significant adhesions or previous abdominal surgeries.

Question 27

what is a classical incision (upper segment vertical)

Answer 27

A vertical incision made in the upper segment of the uterus, typically extending toward the fundus.

Question 28

what are advantages of the upper segment vertical incision (2)

Answer 28

• Provides excellent exposure and access to the upper uterus and abdominal cavity.
• Useful in situations where a large uterine incision is needed.

Question 29

what are disadvantages of the upper segment vertical (2)

Answer 29

• Higher risk of uterine rupture in future pregnancies.
• More blood loss and more difficult to repair.

Question 30

what are indications for an upper segment vertical (9)

Answer 30

• 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