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Low Transverse Cesarean Section (LTCS): Indications, Procedure & Recovery

The low transverse cesarean (Kerr incision) is the standard abdominal delivery approach. A horizontal incision in the lower uterine segment (LUS) minimizes bleeding, rupture risk, and facilitates VBAC.

Indications

  • Cephalopelvic disproportion (CPD)
  • Non‑reassuring fetal status
  • Malpresentation (breech, transverse)
  • Placenta previa / abruption
  • Maternal disease (severe preeclampsia, cardiac)
  • Multiple gestation (often)
  • Prior classical uterine incision
  • Maternal request (after counseling)

Procedure Overview

  1. Anesthesia: neuraxial (spinal/epidural) preferred; general if contraindicated.
  2. Skin: Pfannenstiel (curved suprapubic) or Joel‑Cohen (straight transverse).
  3. Fascia, rectus separation, peritoneum.
  4. Bladder flap (optional).
  5. Low transverse hysterotomy in LUS (thinner, less vascular).
  6. Delivery: head → suction → shoulders → body.
  7. Cord clamping, placenta removal.
  8. Uterine closure: 1‑ or 2‑layer running locked suture.
  9. Reapproximate fascia, subcutaneous (>2 cm), skin (subcuticular).

Recovery

  • Hospital stay: 2–3 days (enhanced recovery pathways → 24–48 h).
  • Pain: scheduled acetaminophen + NSAID; opioid PRN.
  • Early ambulation, oral intake, breastfeeding.
  • Activity restrictions: no heavy lifting >6 weeks; drive when off opioids & comfortable.
  • Full recovery 6–8 weeks.

Risks

  • Infection (endometritis, wound), hemorrhage, thromboembolism, bowel/bladder injury.
  • Cesarean scar ectopic pregnancy (rare, ~1:2000).
  • Future: uterine rupture risk ~0.5–0.9% in VBAC.

Success Rate

>95% maternal/neonatal survival; primary indication drives outcome.

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