There is increased risk in a woman who has had more than one previous cesarean, extensive surgery in the uterus such as a large fibroid removal, or a large uterine scar that travels longitudinal in the muscle of the uterus rather than a thin lower uterine horizontal scar. There is no increased risk with a previous low vertical uterine scar. Previous history of a uterine rupture should preclude a woman from a vaginal delivery in the future because of the high rate of recurrence.
After careful counseling between patient and health care provider, early in prenatal care, more patients can now be considered potential candidates for trial of labor.
New recommendations by the American College of Obstetricians and Gynecologists include allowing a trial of labor in:
• Women with 2 previous cesarean section scars.
• Women with a previous cesarean that now have twin birth.
• Women that have an unknown previous uterine scar.
Women can have the option of taking on added risk associated with a trial of labor, even if they will be delivering in an institute without the capability of emergency cesarean if they are fully informed and well counseled.
Use of certain inducing agents, such as misoprostol (a type of prostaglandin) should not be used to induce labor in women with a previous cesarean because of the increased risk of rupture.
Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.
Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.