Lower segment Caesarean section

{{Short description|Type of caesarean section}}A '''lower''' ('''uterine''') '''segment caesarean section''' ('''LSCS'''), also known as the lower-segment transverse cesarean section, is the most commonly used type of [[caesarean section]], involving a horizontal incision.<ref name="powell01">{{cite journal|last1=Powell|first1=John|title=The Kerr Incision|journal=Journal of Pelvic Surgery|date=2001|volume=7|issue=3|pages=77–78|url=http://journals.lww.com/jpelvicsurgery/Citation/2001/05000/The_Kerr_Incision__John_Martin_Munro_Kerr.15.aspx|accessdate=17 December 2016}}</ref> This procedure is used in order to safely deliver a baby when a vaginal birth is deemed unsafe, involving a horizontal incision at the pubic hair line.<ref>{{Cite web |title=Lower Segment Cesarean Section {{!}} LSCS |url=https://www.ahmedabadivf.com/lscs |access-date=2026-02-22 |website=www.ahmedabadivf.com |language=English}}</ref> {{Infobox medical condition |name = |synonyms =  |image = Pfannenstiel2.JPG

|image_size = |alt = |image_thumbtime = |caption = First description of Pfannenstiel's incision.

|width = |image2 = C-sec suture.jpg

|image_size2 = |alt2 = |image_thumbtime2 = |caption2 = A '''Pfannenstiel incision''' for a [[caesarian section]] closed with [[surgical staple]]s. The [[Anatomical terms of location|superior]] aspect of [[mons pubis]] and [[pubic hair]] are seen at bottom of the image.

|width2 = |pronounce = |pronounce 2 = |specialty =  |symptoms = |complications = |onset = |duration = |types = |causes =  |risks =  |diagnosis = }}

[[File:Cesareo.svg|thumb|Comparison of incisions used for [[caesarean section]]<br> Is: [[Supra-umbilical incision]]<br> Im: [[Median incision]]<br> IM: [[Maylard incision]]<br> IP: [[Pfannenstiel incision]]]] Most commonly, a baby is delivered by making a transverse incision in the lower uterine segment, above the attachment of the [[urinary bladder]] to the [[uterus]]. This type of incision results in less [[Bleeding|blood loss]] and is easier to repair after surgery compared to other types of caesarean sections.<ref>{{Cite web |title=Cesarean Birth: Surgical Techniques {{!}} GLOWM |url=https://www.glowm.com/section-view/heading/Cesarean%20Birth:%20Surgical%20Techniques/item/133 |archive-url=http://web.archive.org/web/20250803071204/https://www.glowm.com/section-view/heading/Cesarean%20Birth:%20Surgical%20Techniques/item/133 |archive-date=2025-08-03 |access-date=2026-02-23 |website=www.glowm.com |language=en}}</ref> This type of incision was developed by the German gynecologist [[Hermann Johannes Pfannenstiel]], who was critical in the development of modern day lower segment cesarean sections, due to his development of this technique, which he gained credit for.<ref>{{Cite journal |last1=Juneja |first1=Sunil Kumar |last2=Tandon |first2=Pooja |last3=Kochhar |first3=Bakul |last4=Singh |first4=Harman Deep |last5=Sharma |first5=Bhanupriya |date=2017 |title=A Rare Case of Transvesical Cesarean Section |journal=International Journal of Applied & Basic Medical Research |volume=7 |issue=3 |pages=205–206 |doi=10.4103/ijabmr.IJABMR_120_16 |doi-access=free|issn=2229-516X |pmc=5590388 |pmid=28904925}}</ref> There are several methods of operation used in order to maximize the safety of the procedure, which are disussed in detail below.

==Method== A vertical incision in the lower uterine segment may be performed in the following circumstances:<ref name=gfmer>[http://www.gfmer.ch/Obstetrics_simplified/caesarean_section.htm Obstetrics Simplified - Diaa M. EI-Mowafi > Caesarean Section] Geneva Foundation for Medical Education and Research. Edited by Aldo Campana, September 4, 2008</ref> * presence of lateral varicosities * constriction ring to cut through it * deeply engaged head The location of an lower segment cesarean section is beneficial for the following reasons:<ref>{{Citation |last1=Sung |first1=Sharon |title=Cesarean Delivery |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK546707/ |access-date=2026-03-05 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31536313 |last2=Mikes |first2=Beverly A. |last3=Martingano |first3=Daniel J. |last4=Mahdy |first4=Heba}}</ref> * peritoneum is more loosely attached to the uterus * There is significantly less bleeding * healing is more efficient * sutures are intact (less problem with suture loosening) Most bleeding takes place from the angles of the incision, and [[forceps]] can be applied to control it. Green Armytage forceps are specifically designed for this purpose.<ref>[http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x5840.html Lower segment Caesarean section] Primary Surgery: Volume One: Non-trauma. Prev. Chapter 10. The surgery of labour</ref>

As a result of the first incision, the bladder is exposed and scissors are used to open the uterus, allowing just enough room to deliver the baby. Any unnecessary incision made could cause unnecessary blood loss.<ref>{{Cite journal |last=Hiramatsu|first=Yuji|date=July 2020|title=Lower-Segment Transverse Cesarean Section|journal=Surgery Journal (New York, N.Y.)|volume=6|issue=Suppl 2|pages=S72–S80|doi=10.1055/s-0040-1708060|issn=2378-5128|pmc=7412711|pmid=32782927}}</ref> Although the incision is made using a sharp scalpel, care must be taken not to injure the [[Fetus|foetus]], especially if the membranes are ruptured, or in emergencies like [[abruptio placenta|abruption]]. The incision can be extended to either sides using scissors or by blunt dissection using hands. While using the scissors, the surgeon should ensure that a finger is placed underneath the uterus so that the foetus in protected from unintentional injury. If [[blunt dissection]] is done, intraoperative blood loss can be minimized. In cases where Pfannenstiel incision cannot be done (such as large baby), [[Kronig incision]] (low vertical incision),<ref>{{Cite journal|date=2017-08-16|title=Cesarean Delivery: Overview, Preparation, Technique|url=http://emedicine.medscape.com/article/263424-overview?pa=ENPYsQNiGZD5joDDafC/xh2Bajrxc9q3Gd96/0jxGF8uEJmuPiOMIE/p2t5HkbC1VKlm2LVbca0sdS0ubYVZnFaycSibeA0Q/JsWK+pGHzs=}}</ref> classical (midline), J<ref>{{Cite journal|last1=Zou|first1=Li|last2=Zhong|first2=Shaoping|last3=Zhao|first3=Yin|last4=Zhu|first4=Jianwen|last5=Chen|first5=Lijuan|date=April 2010|title=Evaluation of "J"-shaped uterine incision during caesarean section in patients with placenta previa: a retrospective study|journal=Journal of Huazhong University of Science and Technology Medical Sciences |volume=30|issue=2|pages=212–216|doi=10.1007/s11596-010-0216-z|issn=1672-0733|pmid=20407876|s2cid=195679609}}</ref> or T-shaped incisions<ref>{{Cite journal|last1=Boyle|first1=J. G.|last2=Gabbe|first2=S. G.|date=February 1996|title=T and J vertical extensions in low transverse cesarean births|journal=Obstetrics and Gynecology|volume=87|issue=2|pages=238–243|doi=10.1016/0029-7844(95)00388-6|issn=0029-7844|pmid=8559531|s2cid=25233309}}</ref> may be used to incise the uterus.<ref>{{cite book|last1=Josef|first1=Fischer|title=Mastery of Surgery|publisher=Lippincott Williams & Wilkins|page=1818|edition=4|url=https://books.google.com/books?id=PgUFJg_-f4YC&q=kerr+incision&pg=PA1818|accessdate=17 December 2016|isbn=9780781771658|date=2006-12-18}}</ref> This type of C-section can allow the woman’s body to heal faster following surgery. It also lessens the likelihood of developing a hernia post-operation.<ref>{{Cite web |last=MD |first=Dr Ananya Mandal |date=2010-04-18 |title=Cesarean Section Types |url=https://www.news-medical.net/health/Cesarean-Section-Types.aspx |access-date=2026-02-12 |website=News-Medical |language=en}}</ref> Lower-segment cesarean sections are less damaging, and cause fewer complications in future pregnancies, allowing women to choose a vaginal delivery for future births.<ref>{{Cite web |last=Services |first=Department of Health & Human |title=Caesarean section |url=http://www.betterhealth.vic.gov.au/health/healthyliving/caesarean-section |access-date=2026-02-13 |website=www.betterhealth.vic.gov.au |language=en}}</ref>

<gallery> File:Anterior wall of uterus.JPG|Abdominal wall incision that exposes anterior wall of the uterus File:Caesarian section - Pull out.jpg|Pulling out the baby File:Caesarian.jpg|Complete extraction of the baby from the uterus File:Caesarian newborn.JPG|Cleaning prior to handing the newborn to the pediatrics team File:Caesarian shown.jpg|Showing the baby to its mother File:Suturing uterus.JPG|Suturing the uterus </gallery>

==Etymology== The German gynecologist [[Hermann Johannes Pfannenstiel]] (1862–1909) invented the technique.<ref>{{cite book|title=Dorland's Illustrated Medical Dictionary|author=Elsevier|publisher=Elsevier|year=2003|isbn=978-0-7216-0146-5|edition=30th|location=[[Philadelphia]]|authorlink=Elsevier|title-link=Dorland's Medical Dictionary}}</ref> In the [[United Kingdom]], the surgery was first popularised by Dr. [[Monroe Kerr]], who first used it in 1911, so in English speaking countries it is sometimes called the Kerr incision or the Pfannenstiel-Kerr incision.

== History == Kerr published the results in 1920, proposing that this method would cause less damage to the vascularized areas of uterus than the classical operation. He claimed that it was better than the longitudinal uterine incision in terms of chances for scar rupture and injury to vessels.<ref>{{cite journal|last1=Powell|first1=John|date=2001|title=The Kerr Incision|url=http://journals.lww.com/jpelvicsurgery/Citation/2001/05000/The_Kerr_Incision__John_Martin_Munro_Kerr.15.aspx|journal=Journal of Pelvic Surgery|volume=7|issue=3|pages=77–78|accessdate=17 December 2016}}</ref> Ferdinand Adolf Kehrer, another German gynecologist, was accredited with being the first gynecologist to use a horizontal incision to begin this operation.<ref>{{Cite journal |last1=Jauniaux |first1=Eric |last2=Bartels |first2=Helena C. |last3=Nieto-Calvache |first3=Albaro Jose |last4=Hussein |first4=Ahmed M. |date=2026-01-01 |title=Evolution of modern cesarean delivery: historic perspective and new challenges |url=https://www.ajog.org/article/S0002-9378(25)00153-X/fulltext |journal=American Journal of Obstetrics & Gynecology |language=English |volume=233 |issue=6 |pages=S557–S568 |doi=10.1016/j.ajog.2025.03.008 |issn=0002-9378 |pmid=41485841|doi-access=free }}</ref> This new method of incision, in combination with methods of anesthesia and the invention of absorptive polymers, began the era of cesarean sections with higher success rates.<ref>{{Cite journal |last1=Jauniaux |first1=Eric |last2=Bartels |first2=Helena C. |last3=Nieto-Calvache |first3=Albaro Jose |last4=Hussein |first4=Ahmed M. |date=2026-01-01 |title=Evolution of modern cesarean delivery: historic perspective and new challenges |url=https://www.ajog.org/article/S0002-9378(25)00153-X/fulltext |journal=American Journal of Obstetrics & Gynecology |language=English |volume=233 |issue=6 |pages=S557–S568 |doi=10.1016/j.ajog.2025.03.008 |issn=0002-9378 |pmid=41485841|doi-access=free }}</ref> {{clear}}

==References== {{reflist}}

==Further reading== * [http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x5840.html Lower segment Caesarean section] Primary Surgery: Volume One: Non-trauma. Prev. Chapter 10. The surgery of labour

[[Category:Obstetric surgery]] [[Category:Caesarean sections]]