In which of the following situations is a vertical (classical) uterine incision most appropriate during caesarean delivery?

• A Elective repeat caesarean at 39 weeks with a well-formed lower segment
• B Posterior placenta praevia at 38 weeks with a formed lower segment
• C Term breech presentation with adequate lower segment
• D Caesarean at 28 weeks for severe pre-eclampsia where the lower segment is thin and poorly developed ✓

Explanation

A classical incision is indicated when the lower uterine segment is unformed or unsafe to enter, classically at very preterm gestations such as 28 weeks, or with obstructing lower segment pathology. At 39 weeks, term breech, and posterior praevia with a formed segment, a transverse lower segment incision is standard because it bleeds less, heals better, and carries a far lower rupture risk in future pregnancies. Preterm gestation with an undeveloped segment is the discriminating factor.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.