The purpose of this study was to compare maternal blood loss, as reflected by the perioperative changes in haemoglobin (Hgb), the incidence of severe bleeding (estimated blood loss > 1000 ml) at operation, and the need for blood transfusion, between patients who had classical caesarean section (CCS) and lower segment caesarean section (LSCS) at 34 weeks gestation or less. The data from 31 women delivered by CSS between 25 and 34 weeks gestation were compared, in a retrospective case-control fashion, to another 31 women delivered by LSCS. Patients were matched for gestational age at delivery, the type of anaesthesia, and the prior use of tocolytic therapy. Excluded from the study were patients who had an antepartum haemorrhage or placenta praevia. There was a significantly greater reduction in maternal Hgb and an higher incidence of severe bleeding in the CSS group compared to the LSCS group (P < 0.05). The results of this study suggest that for preterm caesarean sections, the classical incision is associated with increased blood loss compared to the lower segment incision.