the uterus is also associated with lower risks of uterine rupture. There may be times in which the lower transverse incision does not provide adequate space and therefore, expansions of the low transverse incisions have led to the creation of the low transverse incision with T-extension in the midline, low transverse incision with J-extension, and low transverse incision with U-extension. A low vertical incision and a midline incision, also known as a classic caesarean incision, may be preferred during a labor that is preterm. Since the lower uterine segment is not yet fully developed during a preterm labor, these 2 incisions are preferred in order to provide adequate space for manipulations during delivery of the fetus. A low transverse incision would not provide adequate space and could entrap the fetal head therefore risking intercranial hemorrhage, morbidity and mortality for the fetus. A midline incision may be preferred as well when the fetus lies transversely across the patient's uterus or if the placenta lies in the area where the low transverse incision is made. In practice, however, the midline incision is rarely used. Other hysterotomy incisions include a high transverse incision and a fundal incision. A fundal incision may be used if the placenta is placed behind the anterior wall of the uterus and therefore making typical incisions much more risky for hemorrhage. Techniques Incision A hysterotomy can be performed by various methods. Typically a small incision is made with a scalpel about 1-2 cm long. During a blunt expansion, the incision is expanded by the surgeon's index fingers or other blunt dissection tools. During a sharp expansion, bandage scissors are used to cut a larger incision. Some professionals will say that the sharp expansion allows for a more controlled entry into the uterus and a faster delivery of the fetus. Other professionals will say the blunt expansion allows for reduced risk of hemorrhaging or excessive bleeding and improves healing for the patient. Closure A hysterotomy is completed by closing the uterus either by using a stapler or by suture, no significant differences have been noted to show one technique takes precedent over another. The muscular outer layer of the uterus in all samples of closures showed some inflammation and thickening/scarring of the tissue. In the event a midline incision is used, three layers of sutures are performed to repair the uterine wall. An interrupted suture is used to close the