ABSTRACT
Candidates for trial of labor aer cesarean delivery 397 Contraindications to trial of labor 397
Types of cesarean delivery incisions 397 Abdominal skin incisions 397 Lower-segment transverse cesarean delivery 498
Operative technique 498 Vascular anatomy and uterine hemorrhage control 402 Lower-segment vertical cesarean delivery 403
Operative technique 403 Classical cesarean delivery 403
Operative technique 404 Extraperitoneal approaches to the uterus 404
Technical complications associated with cesarean delivery 404 Adherent bladder 404 Placental obstruction at cesarean delivery 405 Diculties in delivering the fetus 405 Incision into the vagina 405 Fetal monitoring at cesarean delivery 405 Obstetric conditions aecting cesarean delivery 405 Cesarean delivery in the obese patient 406 Remote eects of cesarean delivery 406 Postoperative infection 406 Cesarean hysterectomy 407
Operative complications 409 Injury to the urinary tract 409 Bladder injuries 409 Ureteral injuries 409 Intestinal injuries 409 Incidental pelvic pathology 410
Postoperative course and management 411 Postoperative complications 411
Ileus and obstruction 411 Pulmonary embolism 412 Wound disruption 412
Postmortem cesarean delivery 413 Acknowledgment 413 References 413
Cesarean delivery has had a tumultuous and controversial history. e procedure was seldom used before the end of the nineteenth century because of its prohibitive maternal mortality. However, a dramatic rise in abdominal deliveries has occurred over the past ve decades. e cesarean delivery rate in the United States in 1970 was 5.5% compared with 32.7% in 2013.1-3 is is the latest available statistic at the time of this writing and this rate resulted in 1,284,339 cesarean deliveries in 2013. Several factors have contributed to this change4-6:
1. Women are delaying childbearing, leading to more births among women of older age. is group has a high rate of cesarean deliveries and medical complications.
