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What are risks involved in vertical and horizontal incision C-section?

Thursday, 06 August 2009
Answered by: Dr B Shakuntala Baliga MD (AIIMS), FICOG
Professor and Senior Consultant Gynecologist & Colposcopist Mazumdar-Shaw Center for Cancer Research & Narayana Hrudayalaya Multispecialty Hospital, Bangalore
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Q. I had vertical incision C-section and now I am 34 weeks pregnant and my gynaecologist suggested a second C-section. She told me that I should undergo a horizontal incision C-section this time. Could you please tell me the complications involved in both types of C-section?

A.  I guess you mean a vertical incision on the skin of your abdomen? If yes, the repeat C-section had better be again alongside the previous scar. The previous scar will be excised while closing / suturing the skin; hence you will have only 1 scar. It is possible to do a "horizontal" C-section this time but that will give two scars, which will be unsightly. The advantages of a "vertical" incision is a very fast access into the abdomen (e.g. in cases of bleeding due to placenta previa, severe fetal distress), is less bloody than a horizontal scar, and gives better access to the uterus (as is required in cases of transverse lie, obstructed labour). Disadvantage is that it is slightly more painful in the post-operative period and is more likely to get weakened, resulting in incisional hernia. The additional advantage of a "horizontal" C-section is that it is cosmetically better; however, it is more bloody, takes longer and access to the abdomen is limited compared to the vertical incision. It is obvious that the doctor has to be very experienced in performing a C-section through a horizontal incision. However, keeping in mind the benefits of one incision over the other even an experienced doctor may use his/her wise counsel to select a vertical incision in certain cases.

A.  I guess you mean a vertical incision on the skin of your abdomen? If yes, the repeat C-section had better be again alongside the previous scar. The previous scar will be excised while closing / suturing the skin; hence you will have only 1 scar. It is possible to do a "horizontal" C-section this time but that will give two scars, which will be unsightly. The advantages of a "vertical" incision is a very fast access into the abdomen (e.g. in cases of bleeding due to placenta previa, severe fetal distress), is less bloody than a horizontal scar, and gives better access to the uterus (as is required in cases of transverse lie, obstructed labour). Disadvantage is that it is slightly more painful in the post-operative period and is more likely to get weakened, resulting in incisional hernia. The additional advantage of a "horizontal" C-section is that it is cosmetically better; however, it is more bloody, takes longer and access to the abdomen is limited compared to the vertical incision. It is obvious that the doctor has to be very experienced in performing a C-section through a horizontal incision. However, keeping in mind the benefits of one incision over the other even an experienced doctor may use his/her wise counsel to select a vertical incision in certain cases.

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