Maternal morbidity following cesarean section. Comparison of isthmo-corpus longitudinal section and isthmian transverse section in premature labor

In an increasing number of cases of the Caesarean delivery of small premature babies (length of gestation less than 32 weeks or an estimated weight of less than 1501 g) between April 1983 and March 1987, the uterus was opened by an isthmo-corporeal longitudinal section if the lower uterine segment appeared too narrow for a gentle delivery via an isthmian transverse incision. A comparison of 67 Caesarean deliveries of this type with 116 Caesarean deliveries of the same small premature babies using an isthmian transverse incision did not reveal any difference with regard to postoperative infections, feverish standard morbidity, or other noninfectious complications. In comparison with Caesarean deliveries of older babies, the Caesarean deliveries of small premature babies had significantly more infectious and noninfectious complications, such as cases of phlebitis of the arm owing to intravenous application (2.7% as against 1.0%), posthemorrhaging and hematomas (3.8% as against 0.8%), and blood transfusions (3.3% as against 0.8%). The number of infectious complications was significantly reduced by a perioperative antibiotics prophylaxis. The question of late complications as a result of the isthmo-corporeal longitudinal section, especially the danger of rupture of the uterine scar in the event of a subsequent vaginal delivery, has not yet been resolved.