Lower segment Caesarean section

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A lower (uterine) segment Caesarean section (LSCS), also called the Kerr incision,[1] is the most commonly used type of Caesarean section. It includes a transverse cut 1-2 centimetres above the attachment of the urinary bladder to the uterus, in the lower segment. This type of incision results in less blood loss and is easier to repair than other types of Caesarean sections.

It may be transverse (the usual) or vertical in the following conditions:[2]

  • 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.[3]

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. 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 Kerr incision cannot be done (such as large baby), Kronig incision (low vertical incision), classical, J or T incisions may be used to incise the uterus.[4]

History[edit]

This technique was first used by Dr. Monroe Kerr in 1911. He published the results in 1920, proposing that thish 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.[5]

References[edit]

  1. ^ Powell, John (2001). "The Kerr Incision". Journal of Pelvic Surgery. 7 (3): 77–78. Retrieved 17 December 2016. 
  2. ^ Obstetrics Simplified - Diaa M. EI-Mowafi > Caesarean Section Geneva Foundation for Medical Education and Research. Edited by Aldo Campana, September 4, 2008
  3. ^ Lower segment Caesarean section Primary Surgery: Volume One: Non-trauma. Prev. Chapter 10. The surgery of labour
  4. ^ Josef, Fischer. Mastery of Surgery (4 ed.). Lippincott Williams & Wilkins. p. 1818. Retrieved 17 December 2016. 
  5. ^ Powell, John (2001). "The Kerr Incision". Journal of Pelvic Surgery. 7 (3): 77–78. Retrieved 17 December 2016. 

Further reading[edit]