Uterine Incision Techniques

Abstract

Uterotomy, being the critical step in cesarean delivery, evolved history over milestones until the recent practice of lower segment hysterotomy. The site of primary uterotomy in the lower uterine segment as well as other factors has been related to cesarean scar defect. The debate on making uterotomy involves the minute details of incision creation, technique, extension technique, extension direction, and relationship with the urinary bladder. Uterotomy closure needs to be addressed with reference to number of layers, suture material type, technique of suturing, and anatomical approximation of uterotomy. The impact of uterotomy technique on wound healing in addition to other factors needs attention. Incomplete healing manifests clinically in obstetric practice with significant morbidity such as uterine rupture and scar dehiscence. The impact of uterotomy healing created a significant burden on gynecologic practice. Future challenge is to mitigate morbidity and create measures for effective prevention of morbidity. The preventive measures at primary and secondary level are not necessarily based on reducing cesarean section rate but on standardized technique, training, wound healing, and monitored practice.