Vaginal cesarean section: heir to, but not legacy of Dührssen's incision.

PURPOSE: Vaginal cesarean section is a uterine incision technique derived from Dührssen's incision, with which it is sometimes confused. We report here our experience over 10 years with this technique, with the aim of defining the situations in which it is potentially useful. METHODS: We retrospectively analyzed 24 cases of vaginal cesarean section (i.e. cervico-segmental incision) carried out from 2002 to 2011 in our tertiary maternity unit. This corresponds to an incidence of 1.1 per thousand deliveries. The main outcome measures were the indications and complications of vaginal cesarean section. RESULTS: The study population included 42% nulliparous women. The fetuses concerned had a median gestational age of 24 weeks + 5 days (18 to 34 weeks + 1 day) and a median weight of 595 g (340-1,250 g). The indications for vaginal cesarean section were severe maternal morbidity in 54.2% of cases, failed labor induction in 29.2% and another indication in 16.7%. All but one of the fetuses were dead or nonviable. Surgical complications were observed in three cases: two difficulties achieving hemostatic control and one bladder injury. CONCLUSIONS: Vaginal cesarean section is sometimes considered obsolete, but it has several advantages: technical simplicity, limited tissue dissection, low risk of hemorrhage and no abdominal scar. These features make it particularly suitable for the extraction of medium-sized dead or nonviable fetuses when pharmacological options are ineffective or not rapid enough in cases of poor maternal condition.