What are the maternal implications of a classical caesarean section?

Sixty-two caesarean sections involving a vertical upper uterine segment incision were performed at the Coombe Women's Hospital between January 1983 and December 1995. A detailed chart review was performed. There were no maternal deaths. The maternal outcome was complicated by infection in 49% of cases, and haemorrhage in 19% requiring hysterectomy in two cases. In 15 subsequent pregnancies scar rupture occurred in one case and scar separation in two cases. The perinatal mortality was 200/ 1000; no perinatal death was directly related to the surgery. The operation is associated with a high incidence of maternal morbidity. It also has implications for subsequent deliveries. We recommend that every effort should be made to evaluate critically the need for a caesarean section in the first place and where possible to use a lower uterine segment transverse incision. The patient should be informed of the additional morbidity and long-term risks associated with a vertical incision.