Abstract

To the Editors: We appreciate the interest and the comments of Nishijima et al about our article concerning accidental fetal lacerations during cesarean delivery.1 Nishijima et al recommend transabdominal or transvaginal ultrasonographic examination by the surgeon immediately before the initiation of the operative procedure. We agree with this consideration and think that ultrasonographic findings (such as uterine wall thickness, fetal presentation or orientation, and the amniotic fluid volume) can help the surgeon to characterize the inherent risk to the fetal laceration injury at the cesarean delivery also. Our medical management in the operating theater states always to perform obstetric examination before the performance of cesarean delivery. In cases of doubt about fetal presentation and/or orientation, we do transabdominal and transvaginal ultrasonography. Then, if we observe an abnormal presentation, we use the precautions that we have reported.1 But, despite this management, the risk of accidental fetal lacerations during cesarean delivery may be reduced but not eliminated. Thus, before the performance of cesarean delivery, the patient always should be informed about this risk of accidental fetal lacerations.

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