Hysterotomy

A hysterotomy is an incision made in the uterus.^[1] This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester (or abortion) and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.

There are several types of incisions that can be made, including a midline vertical incision and a low transverse incision. The incision is made using a scalpel and is about 1-2 cm long, but it can be longer depending on the procedure that is performed.^[2] Other types of incisions are low transverse incision with T-extension in the midline, low transverse incision with J-extension, and low transverse incision with U-extension. These are used when low transverse incisions do not provide enough space in order to remove the contents in the uterus.

This incision also comes with possible risks and complications when the incision is made and during repair, including blood loss (possibly leading to anemia), wound infection, fertility problems, premature labor, postoperative pain, and many others.^[3] In addition, a rare form of ectopic pregnancy known as scar ectopic pregnancy can occur. This is when there is abnormal implantation of an embryo onto the scar of the uterus. There is an increased risk of this complication occurring due to trauma from previous procedures utilizing hysterotomies, such as caesarean section and dilation, though the mechanism is unknown.^[4] Closure of the hysterotomy incision made can be done with either a staple or a suture. Sutures are most commonly used, specifically double layer sutures.^[5][3]