Classical Incision Advised In Some Circumstances


SAN FRANCISCO — After the onset of labor, using a classical incision for C-section delivery of a very-low-birth-weight neonate in nonvertex position reduced the risk of intraventricular hemorrhage, compared with a transverse incision or transverse incision with extension, a study of 148 deliveries found.

The decrease in risk was more pronounced for more severe intraventricular hemorrhage (IVH), Dr. Kai Ling Tan and associates reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Previous studies have shown that vaginal delivery is safe for infants in vertex position weighing less than 1,000 g, but data are sparse on rates of IVH after delivery of very-low-birth-weight (VLBW) infants in breech, transverse, or oblique positions.

“It is a constant debate among ob.gyns. in the [morbidity and mortality] conferences in my institution whether to do a classical or a low transverse incision” in these cases, said Dr. Tan of the Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, Wis., in an interview at the poster session.

The current retrospective review found no significant difference in IVH rates between the 93 neonates delivered by classical C-section (27% with IVH) and 58 delivered using one of the two low transverse incisions (34% with IVH). For 94 women who went to C-section after the onset of labor, however, 27% of neonates in the classical incision group had IVH, compared with 54% in the low transverse incisions group, a significant difference.

In the laboring group, severe IVH (grade 3–4) or death occurred in 18% of neonates after a classical incision, and in 50% after a low transverse incision, which also was significant. The lead author of the poster was Dr. Jeffery Garland of Wheaton Franciscan Healthcare-St. Joseph, Milwaukee.

In general, physicians who encounter difficulty delivering an infant through a low transverse incision sometimes use a J or T extension of the incision. VLBW infants may be more vulnerable in these situations, Dr. Tan said. The most common reason for extending uterine incisions is to deliver a nonvertex infant, some reports suggest.

The association between classical incision and decreased risk for IVH in nonvertex, VLBW infants after labor remained significant after controlling for potential confounders, the investigators said.

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