Summary, Cases, Video

Summary

  • Beware preterm labour, malpresentation, PPROM
  • Mentally prepare.  You have the skill set!
  • Do a classical incision rather than risk lateral extension of a transverse incision
  • Inverted T incision if your lower segment incision does not allow necessary maneuvers
  • Anticipate the thickness of the upper segment and the the possibility of going through an anterior placenta.
  • Closure takes longer and requires more sutures.  Be patient!

Case:  Mrs. A.

  • 28 year old G2P1 at 34+1 weeks by early ultrasound presents with mild contractions Q 5 min X 2hrs.
  • Previous LSCS for breech presentation at term.  Vertical skin scar.
  • Uncomplicated pregnancy.  No medical problems.
  • Vital signs stable.  Fetal heart tracing = normal.
  • PV = high presenting part, 2cm dilated.
  • Bedside ultrasound shows transverse lie, back down.
  • SROM for clear fluid shortly after the exam.

  • Repeat exam shows no evidence of cord prolapse.
  • Fetal heart tracing = normal
  • No steroids given.
  • Decision to proceed with emergency cesarean delivery.
  • Spinal anesthesia.
  • Midline skin incision.
  • Lower segment adequate so lower segment transverse uterine incision made.
  • Internal podalic version attempted but unsuccessful after several attempts.
  • Impossible to grasp the infant’s feet or to rotate the head to the fundus.
  • Inverted T-incision, internal podalic version, breech extraction.  Apgars 3 and 8.

Recorded Session (OSS Rounds – February 2022)

Classical C-Sections: Dr. Margaret Burnett РRecording 

Updated on June 23, 2022

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