- 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 – Recording