Cesarean section.

Cesarean section has become a common operation, but its complexity should not be underestimated. Often it must be done as an emergency without skilled assistants; at the same time the surgeon must deal with the maternal disorder that prompted the cesarean section and ensure the well-being of the fetus. Of further concern is the operative blood loss, which can be massive, and the postoperative morbidity, which is often high. The operative technique has evolved from an intraperitoneal vertical incision on the body of the uterus (classical cesarean section) to a near-complete reliance on a retroperitoneal transverse incision (lower segment cesarean section). The historic reason for this change was the fear of peritonitis postoperatively. Present-day practice favours the lower segment operation and emphasizes the reduced operative blood loss and the more secure uterine scar as reasons for the choice. Operative complications (injury to the fetus, lacerations of the uterus and vagina) are the result of inadequate uterine incisions. The classical incision has the advantage of being easily extended and thus has a continued purpose. Postoperative febrile morbidity is attributed to endometritis; the mixed aerobic and anaerobic bacteria of the vagina are the causal organisms. Febrile morbidity can be prevented by antibiotics given prophylactically.