Document Detail


The case for trial of labor in the patient with a prior low-segment vertical cesarean incision.
MedLine Citation:
PMID:  9240598     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our purpose was to review recent obstetric literature detailing the subsequent delivery experience of patients with a prior low-segment vertical cesarean incision and to derive recommendations for practice on the basis of this information. STUDY DESIGN: Ten studies that included information about pregnancy outcome in patients with prior low-segment vertical cesarean operations were retrieved and reviewed from the American obstetric literature since 1981 and from a review of all abstracts presented annually since 1981 to the Society of Perinatal Obstetricians. RESULTS: Altogether, information about subsequent pregnancy outcome for 382 patients with prior low-segment vertical cesarean delivery was available for analysis. Among the 372 patients with complete patient population information, vaginal delivery was safely accomplished in 306 (82%). Four uterine ruptures (1.05%) have been reported, only one of which occurred after a single prior unextended low-segment vertical cesarean incision. Two ruptures occurred elsewhere on the lateral or posterior aspect of the uterus in subsequent pregnancies, and the fourth rupture occurred at the juncture of prior low vertical and transverse incisions. No perinatal mortality or permanent perinatal morbidity was encountered with these pregnancies. CONCLUSIONS: In the otherwise uncomplicated pregnancy the patient with one previous nonextended low-segment vertical cesarean incision should be considered to have a prior low-segment scar and as such be a candidate for trial of labor in her current singleton pregnancy. The same care, counseling, and caution should be exercised for this patient as for one with a prior low-segment transverse incision.
Authors:
J N Martin; K G Perry; W E Roberts; E F Meydrech
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  177     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-08-19     Completed Date:  1997-08-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  144-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
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MeSH Terms
Descriptor/Qualifier:
Birth Weight
Cesarean Section / methods*,  standards
Counseling
Decision Making
Female
Gestational Age
Humans
Incidence
Maternal Welfare
Obstetric Labor Complications / epidemiology
Physician's Practice Patterns
Pregnancy
Pregnancy Outcome
Trial of Labor*
Vaginal Birth after Cesarean / standards*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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