- Arrest of the first or second stage
- Fetal malposition (e.g. OP, asynclitic)
- Failed forceps or vacuum delivery
- Abnormal fetal heart rate
- Factors cluster into the following categories of risk factors for lateral extension of a transverse uterine incision:
- Difficulty of extraction
- Urgency of delivery
- Poorly developed lower segment
- In cases predisposed to an “inadequate” lower segment, the best prevention is to avoid making a transverse lower segment incision. It is much safer to make a lower segment, vertical incision that can be extended into the upper segment if necessary.
- In the case of second stage arrest cesarean sections, consider moving your incision site 2 fingerbreadths cephalad.
- To expand an incision, do so bluntly in a cephalocaudal direction, or extend in the midline making an inverted T incision.
- With a narrower lower segment, use bandage scissors.