*5.3.1 Transverse abdominal incisions*

The full thickness abdominal wall incision should be adequate to allow easy delivery of the fetus. At least a minimum incision of 15 cm to allow bladder retractor with ease.

1.Pfannensteil incision is made transversely on the suprapubic area approximately 2-3 cm above the symphysis pubis and should be curvilinear, with the lateral apices of the incision curved slightly up toward the anterior superior iliac spines. The incision is performed sharply to the level of the rectus fascia. The fascia is incised with the scalpel in the transverse manner to expose the muscles. The incision in the anterior rectus fascia may be extended laterally

using the scalpel or dissecting scissors. Watch out for the superficial epigastric and superficial circumflex iliac veins. It is important to minimise the risk of haematoma. After the is incised, the anterior rectus sheath is then dissected from the underlying rectus muscle both in the cephalic and caudal direction using blunt and sharp dissection. Care must be taken to identify perforating vessels between the rectus muscles and the anterior fascia. Peritoneum should be exposed staying in the midline and avoid hooking fingers under the rectus muscles which can damage the underlying vessels. The entry through the peritoneum should be made high in the operative field to avoid injury to the bladder. The peritoneum should be elevated using artery forceps and palpate the intended entry point to exclude small bowel that may be trapped.

