A lower (uterine) segment Caesarean section (LSCS) is the most commonly used type of

Caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

. Most commonly to deliver the baby a

transverse incision Transverse may refer to: *Transverse engine, an engine in which the crankshaft is oriented side-to-side relative to the wheels of the vehicle *Transverse flute, a flute that is held horizontally *Euler force, Transverse force (or ''Euler force'') ...

is made in the lower uterine segment above the attachment of the

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

to the uterus. This type of incision results in less

blood loss Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

and is easier to repair than other types of Caesarean sections.

Method

A vertical incision in the lower uterine segment may be performed in the following circumstances:Obstetrics Simplified - Diaa M. EI-Mowafi > Caesarean Section
Geneva Foundation for Medical Education and Research. Edited by Aldo Campana, September 4, 2008 * presence of lateral varicosities * constriction ring to cut through it * deeply engaged head The location of an LSCS is beneficial for the following reasons: * peritoneum is more loosely attached to the uterus * contraction is less than in upper part of uterus * healing is more efficient * sutures are intact (less problem with suture loosening) Most bleeding takes place from the angles of the incision, and forceps can be applied to control it. ''Green Armytage forceps'' are specifically designed for this purpose. Although the incision is made using a sharp scalpel, care must be taken not to injure the foetus, especially if the membranes are ruptured, or in emergencies like

abruption Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 Gestational age (obstetrics), weeks of pregnancy. Symptoms may include vaginal bleeding, lower ...

. The incision can be extended to either sides using a scissor or by blunt dissection using hands. While using the scissors, the surgeon should ensure that a finger is placed underneath the uterus so that the foetus in protected from unintentional injury. If blunt dissection is done, intraoperative blood loss can be minimized. In cases where Pfannenstiel incision cannot be done (such as large baby),

Kronig incision Kronig or Krönig may refer to: People: *Alfred Kronig (1928–2020), Swiss cross country skier who competed in the 1950s * August Karl Krönig (1822–1879), German chemist and physicist *Ralph Kronig (1904–1995), German-American physicist note ...

(low vertical incision), classical (midline), J or T shaped incisions may be used to incise the uterus. File:Anterior wall of uterus.JPG, Abdominal wall incision that exposes anterior wall of the uterus File:Caesarian section - Pull out.jpg, Pull-out of the newborn baby File:Caesarian.jpg, Complete extraction of newborn out of the womb File:Caesarian newborn.JPG, Cleaning prior to handing the newborn to the pediatrics team File:Caesarian shown.jpg, Chance for ''mom'' to meet the baby File:Suturing uterus.JPG, Suturing of the uterus

Etymology and history

The German gynecologist

Hermann Johannes Pfannenstiel Hermann Johannes Pfannenstiel (28 June 1862 – 3 July 1909) was a German gynecologist born in Berlin. In 1885 he received his doctorate in Berlin and afterwards worked as a hospital assistant in Posen. He later moved to Breslau, where in 18 ...

(1862–1909) invented the technique. In the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...

, the surgery was first popularised by Dr.

Monroe Kerr Monroe or Monroes may refer to: People and fictional characters * Monroe (surname) * Monroe (given name) * James Monroe, 5th President of the United States Places United States * Monroe, Arkansas, an unincorporated community and census-designat ...

, who first used it in 1911, so in English speaking countries it is sometimes called the Kerr incision or the Pfannenstiel-Kerr incision. Kerr published the results in 1920, proposing that this method would cause less damage to the vascularized areas of uterus than the classical operation. He claimed that it was better than the longitudinal uterine incision in terms of chances for scar rupture and injury to vessels.

Method

Etymology and history

References

Further reading