Extraperitoneal cesarean section revisited.

A retrospective analysis was made of 186 consecutive primary cesarean sections performed on patients at high risk for infection to determine whether extraperitoneal cesarean section would have decreased the incidence of infections and other complications. Women who theoretically would have benefited most from extraperitoneal cesarean section were not candidates for the procedure because of technical reasons, while those who would have been candidates for the procedure did very well despite the fact that the procedure was not done. Except for somen with severe toxemia, prophylactic antibiotics markedly reduced febrile morbidity. A number of significant unsuspected pathologic conditions also would not have been diagnosed if the extraperitoneal cesarean section technique had been used. It is concluded that prophylactic antibiotics and intraperitoneal cesarean sections are the preferred techniques even for those women with apparent amnionitis.