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The modern caesarean section 

The modern caesarean section
Chapter:
The modern caesarean section
Author(s):

Eric Jauniaux

and Vincenzo Berghella

DOI:
10.1093/med/9780198758563.003.0005
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date: 24 May 2020

The caesarean delivery surgical procedure has evolved considerably over the last 100 years. The Pfannenstiel–Kehrer technique is currently the most widely used caesarean procedure and is reviewed in detail in this chapter and complemented with videos. Recent evidence-based evaluation of the different steps of this procedure has shown that uterine exteriorization is safe and is particularly useful when visualization of the incision is difficult; single-layer closure of the uterine incision is associated with a decreased operative procedure time, and locked (but not unlocked) single-layer closures are associated with a higher risk of uterine rupture, compared to double-layer closure, in women attempting vaginal birth after caesarean delivery. There is also evidence that closure of the subcutaneous layer is beneficial in all women with a ≥2 cm of subcutaneous tissue. High-risk caesarean deliveries include procedure performed at full dilatation, multiple repeat procedures, placenta praevia (accreta and non-accreta), and for obese women.

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