From the Guidelines
A classical incision in a cesarean section is referred to as a classical hysterotomy, which is a vertical uterine incision extending into the upper muscular portion of the uterus. This type of incision is associated with more frequent perioperative morbidities than low transverse cesarean delivery, as well as an increased risk of uterine rupture in future pregnancies 1. The classical hysterotomy is typically used in situations where a lower uterine segment transverse incision is not feasible, such as in cases of extreme prematurity or fetal malpresentation. Key characteristics of the classical incision include:
- A vertical cut made in the upper portion of the uterus
- Extension into the upper muscular portion of the uterus
- Increased risk of uterine rupture in future pregnancies
- Associated with more frequent perioperative morbidities than low transverse cesarean delivery The use of classical hysterotomy is generally reserved for specific situations due to its associated risks, and the lower uterine segment transverse incision remains the preferred method for most cesarean deliveries 1.
From the Research
Classical Incision in C-Section
- A classical incision in a cesarean section (C-section) is a vertical incision made in the upper part of the uterus, also known as a vertical hysterotomy 2.
- This type of incision is typically used in cases where access to the lower uterine segment is difficult, such as in preterm labor, dense adhesion, or placenta previa/accreta 2, 3.
- The classical incision has the advantage of being easily extended, but it is associated with a higher risk of uterine rupture in subsequent pregnancies 2, 4.
- Studies have shown that the risk of uterine rupture after a classical incision is around 1-12% in subsequent pregnancies, depending on the specific circumstances 5, 4.
Comparison with Low Transverse Incision
- The low transverse incision is the most common type of incision used in C-sections, and it is generally considered to be safer and more effective than the classical incision 6.
- However, in certain situations, such as preterm labor or obstructing lesions, a low vertical incision may be preferred over a low transverse incision 3.
- Research has shown that the low vertical incision has more advantages and less dangers than a classical fundal incision, and it may be a viable alternative in certain cases 3.
Risks and Complications
- The classical incision is associated with a higher risk of uterine rupture, hemorrhage, and adhesion compared to the low transverse incision 2, 5.
- However, studies have also shown that the risk of organ injury may be lower with a low vertical incision compared to a low transverse incision 5.
- Overall, the choice of incision type depends on the specific circumstances of the pregnancy and the individual patient's needs 2, 3.