Lower Segment Transverse Cesarean Section
Abstract
This study focuses on lower-segment transverse cesarean section (LSCS) as the
preferred approach due to its advantages in healing, reduced complications, and better
maternal outcomes. Surgical difficulty varies based on maternal obesity, fetal
malpresentation, multiple gestations, prior CS, abnormal placentation, and uterine
abnormalities such as fibroids. Emergency CS requires rapid decision-making to prevent
maternal and fetal distress, increasing risks of complications like excessive bleeding,
uterine rupture, and placenta accreta spectrum disorders. Bilateral tubal ligation (BTL) is
commonly performed concurrently in women opting for permanent contraception, while
adhesiolysis is necessary in cases of severe intra-abdominal adhesions from previous
surgeries. Complications include excessive bleeding, difficult fetal extraction, bladder or
bowel injury, and long-term issues such as cesarean scar defects, which may contribute
to abnormal placental implantation and future pregnancy risks. Evidence-based
techniques focus on minimizing trauma, improving hemostasis, and optimizing
postoperative recovery through Enhanced Recovery After Surgery (ERAS) protocols.
Proper preoperative assessment, meticulous intraoperative technique, and structured
postoperative care are essential for improved surgical outcomes.
Critical Analysis
This study focuses on LSCS as the most commonly performed cesarean
technique, offering better maternal recovery and lower complication rates compared to
classical incisions. Maternal factors, including obesity, prior CS, and abnormal placental
attachment, increase surgical complexity. Placenta accreta spectrum disorders, often
linked to prior uterine surgeries, pose a high risk for massive hemorrhage, requiring
advanced planning and potential hysterectomy. Emergency CS demands rapid
execution, increasing the risk of intraoperative complications. BTL during CS is frequently
performed but may be challenging in cases of excessive bleeding or difficult anatomical
positioning. Adhesiolysis is necessary in patients with previous surgeries, as dense
adhesions can prolong operative time and elevate the risk of bladder and bowel injury.
Techniques such as the Misgav-Ladach method reduce tissue trauma and improve
recovery. Postoperative complications, including cesarean scar defects, contribute to
long-term risks like abnormal placentation and uterine rupture. ERAS protocols,
incorporating early ambulation, multimodal pain management, and infection prevention,
optimize recovery and reduce hospital stays. Surgical proficiency, adherence to best
practices, and individualized patient care improve maternal and fetal outcomes.
Recommendation
I recommend preoperative imaging, such as ultrasound or MRI, to assess placental
positioning and uterine integrity in patients with prior CS or suspected abnormal
placentation. In cases requiring adhesiolysis, meticulous dissection should be performed
to minimize bladder and bowel injury. BTL should be carefully evaluated intraoperatively,
ensuring hemodynamic stability before proceeding. The Misgav-Ladach technique should
be considered to reduce operative time and postoperative complications. I strongly
advocate for ERAS protocols, emphasizing early mobilization, multimodal pain control,
and optimal wound care to enhance recovery. Further research on cesarean scar defects
and their prevention is essential to mitigate risks associated with future pregnancies. By
integrating these strategies, obstetricians can improve surgical efficiency, minimize
complications, and enhance maternal outcomes.
Reference (APA format)
Hiramatsu Y. (2020). Lower-Segment Transverse Cesarean Section. Surgery journal
(New York, N.Y.), 6(Suppl 2), S72–S80. https://doi.org/10.1055/s-0040-1708060
Submitted by: AMBER MAE L. DEOCAMPO BSN 4- NIGHTINGALE
Year & Section
Submitted to: AIRENE I. DORENDO, RN, MN
Clinical Instructor
