{
    "abstract": "The purpose of this study was to determine the factors that influence physician preference for type of hysterotomy incisions in gravidas with a singleton or twin pregnancy undergoing cesarean section under 28\u2009weeks, and to assess factors that result in delivery complications, defined as either intraoperative dystocia or hysterotomy extension. We hypothesized that compared to those with non-cephalic presentations, gravidas with a presenting fetus in cephalic presentation would have higher rates of low-transverse cesarean section, and reduced rates of delivery complications with low-transverse hysterotomy.\nThis was a retrospective cohort chart analysis of 128 gravidas between 23 0/7 and 27 6/7\u2009weeks undergoing cesarean section at a single academic institution between August 2010 and December 2022. Data was abstracted for factors that might influence the decision for hysterotomy incision type, as well as for documentation of difficulty with delivery of the fetus or need for hysterotomy extension to affect delivery.\nThere was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), \nIn pregnancies under 28\u2009weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.",
    "authors": [
        {
            "affiliation": "Cooper Medical School of Rowan University, Camden, NJ, USA.\nDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA.",
            "firstname": "Richard L",
            "initials": "RL",
            "lastname": "Fischer"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA.",
            "firstname": "Danielle",
            "initials": "D",
            "lastname": "Schenker"
        },
        {
            "affiliation": "Cooper Medical School of Rowan University, Camden, NJ, USA.",
            "firstname": "Jason",
            "initials": "J",
            "lastname": "Gosschalk"
        }
    ],
    "conclusions": "In pregnancies under 28\u2009weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.",
    "copyrights": null,
    "doi": "10.1080/14767058.2024.2358385",
    "journal": "The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians",
    "keywords": [
        "Low-transverse cesarean section",
        "classical cesarean section",
        "hysterotomy extension",
        "intrapartum dystocia",
        "periviable delivery"
    ],
    "methods": null,
    "publication_date": "2024-06-18",
    "pubmed_id": "38887786",
    "results": "There was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), ",
    "title": "Cesarean section prior to 28 weeks' gestation: which type of uterine incision is optimal?",
    "xml": "<Element 'PubmedArticle' at 0x788503689b70>"
}