Should a third caesarean section be performed horizontally or vertically?

The article is written by Master, Doctor Nguyen Nhu Thu Truc - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Nha Trang International General Hospital.

There are two methods applied for caesarean section: horizontal caesarean section and longitudinal caesarean section. Each surgical method has its own advantages and disadvantages. So for the 3rd caesarean section, should it be horizontal or vertical?

A caesarean section is the process of removing a baby by cutting open the mother's lower abdomen and uterus. If you have a caesarean section for the first and second time, the wound will heal very quickly, and the third time will be slower.
Pregnant women should also pay attention to enough time to get pregnant between 2 times. Usually, the interval between the 3rd and 2nd pregnancy should be at least 2 years apart.
The more caesarean section, the higher the risk the mother faces, the more severe the severity. The 3rd birth, pregnant women may encounter risks such as:
Cracking, rupture of the uterus This is the most dangerous risk that a pregnant mother having a 3rd caesarean section may encounter, which can affect her health and life. of pregnant women and fetuses. The shorter the time between cesarean deliveries, the higher the risk of uterine rupture or rupture. The cause of this condition is due to uterine scars left by 2 previous surgeries. This scar area is the weakest and most loosely linked, so when the uterus contracts, it will cause rupture and rupture when the fetus is large. Placental abnormalities such as: Placenta praevia, placental abruption, etc., easily cause complications such as postpartum hemorrhage or hysterectomy. The phenomenon of intestinal adhesions Loss of more blood: Women who give birth by caesarean section for the third time, have a longer risk of blood loss and wound healing than women who have had the first and second surgery. 3rd time will take longer Risk of wound infection is higher Affects the process of stimulating milk production and lactation.

Longitudinal caesarean section is the most commonly performed incision in cesarean sections in the past. The doctor will make an incision between the mother's abdomen and uterus to remove the baby. The advantage of this incision is that it is spacious and easy to remove the baby, especially in cases where the baby is lying in a difficult position: horizontal or oblique. Then, the doctor will stitch the incision with non-absorbable sutures and cut the sutures after 5-7 days. However, vertical surgery has many limitations such as cosmetic loss that makes pregnant women lose confidence when wearing their favorite clothes, longer recovery time, leaving scars from the abdomen along the side of the pubic bone,...

This method makes a horizontal incision in the lower abdomen and takes the baby out of the womb through that incision. Transverse surgery helps to overcome the limitations of vertical surgery such as: the incision is easily mixed into the abdominal folds, which is difficult to detect, and the incision heals faster.
The horizontal or vertical incision is selected depending on the pregnancy status, the indication at the time of surgery or the incision location of the previous surgeries. Recently, doctors have chosen a horizontal incision (Bikini line) to ensure the aesthetics of pregnant women and create confidence for mothers who have had a caesarean section. However, in cases where the pregnant mother has an old surgical scar along the longitudinal line, the doctor will operate again according to the old line. In the case of surgery with the baby lying on the side, it is difficult to catch the baby, doctors can use the vertical incision. In addition, in the case of emergency surgery due to fetal distress, the mother has other diseases such as large uterine fibroids, ovarian cysts.. doctors can perform longitudinal surgery to urgently handle the emergency and handle the emergency. you come.

During the antenatal check-up, the pregnant woman should inform the doctor about the information in the previous caesarean sections such as: What is the 1st and 2nd caesarean section, how long apart, the possibility of recovery of previous incisions such as: How... A thorough antenatal examination helps to detect accompanying diseases as well as difficult positions of the baby through which the doctor determines the active incision.

Actively monitor the body changes during the 3rd pregnancy as well as the previous incision. If you see any signs such as: Bleeding, old incision pain, you need to go to a medical facility immediately.

Select reputable hospitals, ensure the requirements of high level of doctors, modern equipment facilities... to make the caesarean section.

Take the initiative to give birth by cesarean section 1-2 weeks before the due date to avoid the risk of scarring of the old incision, which is very likely.
The 3rd caesarean section will not be the same as the previous 2, because the risk of complications for pregnant women and babies will be higher. Therefore, pregnant mothers who need to have a third cesarean section need to pay special attention to the above things to keep themselves and their babies safe.
Currently, Vinmec International General Hospital currently has a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. birthing process Newborns receive comprehensive care.