A cesarean section is performed at 25 weeks gestation for severe fetal anomaly with maternal indication. The lower uterine segment is thin, barely formed, and poorly vascularised. Which uterine incision is most appropriate?

• A Vertical incision through the upper uterine segment ✓
• B Low transverse incision through the lower segment
• C J-shaped extension of a low transverse incision
• D Fundal transverse incision

Explanation

When the lower segment is undeveloped, as in very early gestation, with transverse lie or dense adhesions, a classical vertical incision through the upper segment gives better access and avoids uncontrolled tearing into the uterine vessels. B low transverse incision risks ragged extension laterally into the broad ligament. The trade-off is a weaker scar with higher rupture risk in future pregnancies.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.