Extraperitoneal lower segment caesarean section for infected cases

Abstract

The relative merits of intraperitoneal and a modified extraperitoneal lower segment Caesarean section were studied in 412 septic cases requiring Caesarean section. Our modified technique of extraperitoneal Caesarean section is clearly shown to be far safer than the customary intraperitoneal operation for septic cases requiring Caesarean section. The benefits of the extraperitoneal approach in septic cases are: (a) the risk of maternal death was reduced about 5-fold; (b) the risk of postoperative septicaemic shock was reduced about a-fold; generalised peritonitis, about 4½-fold; pelvic abscess, about 14-fold; and the need for further surgery, about 2½ -fold; (c) the risk of late secondary haemorrhage was reduced about 4-fold. The risk of superficial abdominal wound sepsis was slightly increased. As opposed to other techniques of extraperitoneal Caesarean section, the modified technique employed in this series did not result in any additional risk of haemorrhage or injury to the bladder at operation, in comparison with the intraperitoneal technique, even in the hands of junior staff. The operating time was lengthened by about 3 or 4 minutes.

S. Afr. Med. J., 48, 788 (1974).