Comparative safety of the low transverse versus the low vertical uterine incision for cesarean delivery of breech infants.

Little is known about the comparative safety of the low transverse versus the low vertical uterine incision for cesarean delivery of singleton infants in breech presentation. To address this question, the short-term maternal and infant complications of 221 breech deliveries by low transverse incision and 195 by low vertical incision were analyzed. The perinatal mortality rate associated with the low transverse incision was significantly lower than that associated with the low vertical incision (41 versus 92 deaths per 1000 births; P less than .05). When standardized for birth weight or gestational age, the difference was no longer statistically significant (P greater than .05). The incidences of an Apgar score of 6 or lower, extension of the uterine incision, a decrease in hematocrit by 6 points or more, blood transfusion, and maternal fever were not significantly different. Since these types of incisions appear to have comparable safety, the possibility of a vaginal delivery with later pregnancies suggests that the low transverse uterine incision is preferable to the low vertical incision.