Refinements in performing a cesarean delivery.

Several refinements in performing a cesarean delivery have been proposed in recent years. The surgeon is now more aware of the potential of HIV virus exposure and is inclined to use techniques to minimize contact with sharp objects. Wide incisions of the skin and fascia are encouraged for greater ease in delivering the fetus. When possible, a low transverse uterine incision is attempted to allow for an improved chance of undergoing successful labor with any subsequent pregnancy. Spontaneous delivery of the placenta may reduce blood loss and decrease the chance of postoperative endometritis. Single layer closure of the uterus without closure of the peritoneum is as safe and effective as a two-layer closure. Not closing the visceral or parietal peritoneum appears to be an acceptable alternative. Superficial wound disruption may be minimized by either closing large, nondraining subcutaneous spaces or using continuous drainage. Limitations with descriptive experiences and randomized clinical trials should be appreciated when translating this information into routine surgical practice.