Classical Caesarean Section Revisited in Modern Obstetrics

Objective: To review the incidence, indications, characteristics, and clinical outcomes of classical Caesarean section at a regional hospital in Hong Kong. Methods: This was a retrospective case-series study of all women who underwent a classical Caesarean section over an 8-year period from 1 January 2008 to 31 December 2015 in our unit. Epidemiological data, indications for classical Caesarean section, and maternal and neonatal outcomes were analysed. Results: There was an increasing trend of performing classical Caesarean section, both in our unit and other obstetrics units in Hong Kong under the Hospital Authority. Three main indications for classical Caesarean section were identified in our patients, including vascular lower segment, lower segment not well formed or inaccessible, and lower-segment uterine fibroids. The most common indication in our cohort was vascular lower segment due to placenta praevia with or without accreta. Compared with the groups of lower segment not well formed or inaccessible and lower-segment uterine fibroids, the total blood loss, need for subsequent secondary measures including compression suture and uterine artery embolisation, and admission to intensive care unit were statistically significantly highest in the vascular lower segment group. Conclusion: Classical Caesarean section remained in its role in modern obstetrics for indications of placenta praevia, preterm delivery, as well as fibroids complicating pregnancies as demonstrated in our cohort study. As such, obstetricians should become adept at performing a classical Caesarean section because many cases will not have been predicted or will be required as an emergency procedure. With active involvement of consultants, a multidisciplinary approach and continuous training, the clinical outcome of classical Caesarean section can be reasonably good. Hong Kong J Gynaecol Obstet Midwifery 2017; 17(2):86-93