During a caesarean section for a transverse lie with a low vertical uterine incision, the surgeon requires extensive access and decides to use a transverse abdominal incision that divides the rectus muscles. Which incision is this?

• A Pfannenstiel incision
• B Joel-Cohen incision
• C Midline subumbilical incision
• D Maylard incision ✓

Explanation

The Maylard incision is a transverse suprapubic incision in which both rectus muscles are cut transversely after ligating the inferior epigastric vessels, giving excellent lateral exposure while retaining cosmetic acceptability. The Pfannenstiel and Joel-Cohen are fascial incisions that spare the muscles and offer limited lateral access. A midline vertical incision also provides exposure but is not a transverse muscle-cutting incision.

Reference: Munro Kerr's Operative Obstetrics, 13th ed.

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