Abstract We report a case of 40yr old female G4P3L3 previous 3 caesarean sections in a known case of chronic hypertension with superimposed preeclampsia taken up for emergency hysterotomy with bilateral tubal ligation. Dense omental adhesions noted intraoperatively. Decision for a classical incision for hysterotomy taken. Patient required ICU admission in postoperative period and blood transfusion due to blood loss of 1200cc. The choice of uterine incision needs to be individualised for every patient weighing benefits vs risks based on gestational age, fetal presentations, uterine and fetal anomalies, adhesions and placental abnormalities.