What Is a Uterine Incision?

Karize Uy

A uterine incision is a type of surgical incision often used on pregnant mothers to deliver their babies through a caesarian section. A more medical and formal term for the incision is “hysterotomy." There are three basic types of hysterotomies, both of which are vertically done, called the classic and the low vertical incisions. The low transverse, on the other hand, is a horizontal type of uterine incision. Uterine incisions can also be done if the fetus inside the womb needs to be operated on, but does not necessarily need to be delivered.

General anesthesia may be administered prior to a c-section.
General anesthesia may be administered prior to a c-section.

The classical, or the “high,” incision is said to be the first and the original uterine incision and is performed using a vertical cut in the mid-area of the abdomen above the belly button, allowing for a large opening. It has, however, been used less often because the incision usually produces more bleeding and risk of infection that can be harmful for the mother, as well as a large and unattractive scar or keloid post-surgery. The classical incision is still used in very dangerous and complicated pregnancies such as if the baby’s position is unusual or if the baby is still too small but needs to be delivered immediately. Mothers who have undergone the classical incision are often not allowed to deliver a vaginal or natural birth in succeeding pregnancies because of high risk of uterine rupture.

Very heavy bleeding may occur during the first week after having a c-section.
Very heavy bleeding may occur during the first week after having a c-section.

As a replacement for the classical incision, the low vertical incision is performed because of fewer incidences of uterine ruptures, bleeding, and having a quicker recovery period. This is due to the fact that the incision penetrates through the thinner area of the womb. This uterine incision is created near the pubic area and can be lengthened upwards if a larger opening is needed. It is often performed if the baby is in a breech position, where the buttocks or the feet are closest to the birth canal, unlike the head-first position. Vaginal birth after a low vertical incision can still be possible, but the risk of uterine rupture is still present.

A uterine incision is typically stitched or stapled and then dressed with sterile bandages to reduce the risk of infection.
A uterine incision is typically stitched or stapled and then dressed with sterile bandages to reduce the risk of infection.

The most common and “cosmetically pleasing” uterine incision is the low transverse incision, popularly known as the “bikini cut,” often done in normal deliveries. The vertical incision is performed above the pubic hairline, making it easy to conceal the post-surgery scar. Other advantages of the low transverse incision are much less bleeding, fast recovery period, and less tissue and internal scarring. Uterine ruptures in succeeding deliveries are also unlikely, which means a mother can give birth naturally even after having a c-section. The downside, however, is that the incision can be extended sideways to a limited degree, although incision extension is often not needed in normal pregnancies.

A uterine incision may be closed using an absorbable suture.
A uterine incision may be closed using an absorbable suture.
While rupture is rare, it is most common among women attempting a vaginal delivery after a previous uterine incision.
While rupture is rare, it is most common among women attempting a vaginal delivery after a previous uterine incision.
If germs enter an incision site, it can lead to a dangerous infection.
If germs enter an incision site, it can lead to a dangerous infection.

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