All of these may be considered for a classical caesarean section, EXCEPT?
LEARNING TIP: ANY CONDITION WHERE APPROACH TO LOWER SEGMENT IS DIFFICULT, WE CAN GIVE AN INCISION IN THE UPPER SEGMENT, A CLASSICAL CAESAREAN SECTION When placenta is placed posteriorly there is no difficulty in approach to lower segment, hence an LSCS would be preferable here as it is associated with less incidence of scar morbidity in next pregnancy, compared to classical cesarean section Following are indications of classical caesarean section: Difficulty in safely entering the lower uterine segment because the bladder is densely adherent from previous surgery, a myoma occupies the lower uterine segment, or the cervix has been invaded by cancer. Transverse lie of a large fetus, especially if the membranes are ruptured and the shoulder is impacted in the bih canal Some cases of placenta pre with anterior implantation, especially in the case where the placenta has grown through a prior uterine incision (placenta percreta)
Previous LSCS with dense bladder adhesions
Posterior placenta
Large lower uterine segment fibroid
Massive maternal obesity precluding safe access to LUS
Caesarean section