Abstract Caesarean section of extremely low birth-weight (ELBW) infants is sometimes challenging for obstetricians. To date, there have been no standard types of uterine incision to achieve an atraumatic birth for ELBW foetuses with the placenta covering the whole anterior uterine wall. We present seven cases of transverse fundal uterine incision to avoid incision into the placenta. All the seven cases had successful en caul deliveries (the mean birth weight, 619 ± 213g), accompanied by good neonatal conditions. Transverse fundal uterine incision may be a safe and feasible caesarean technique in ELBW infants when incision into the placenta is otherwise unavoidable.