Abstract
Vaginal birth after prior cesarean has become a part of routine obstetric care over the past three decades. Recently, however, the pendulum has swung in the other direction with a decreasing proportion of women choosing to undergo a trial of labor after prior cesarean. Since more than one-fourth of all deliveries are via cesarean, counseling patients regarding the risks and benefits of undergoing a trial of labor in a subsequent pregnancy is a skill all clinicians who care for obstetric patients should have. In particular, there is good evidence regarding risk factors that change the chance of success in a subsequent trial of labor as well as that of a uterine rupture. For example, women with a prior indication for cesarean that is nonrecurring (e.g. breech, previa, herpes), women with a prior vaginal delivery, and those who present in spontaneous labor all have an increased chance of success in a subsequent trial of labor. Women with more than one prior cesarean, who undergo induction of labor, are treated with prostaglandins, and who have prior classical cesareans are at increased risk for uterine rupture. Using this evidence to counsel women regarding their risks and chances of success in a subsequent trial of labor is paramount to ensuring that a well-informed decision has been made.
Keywords: prior cesarean, uterine rupture, induction of labor
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RARE CASES IN GYNECOLOGY-OBSTETRICS
With the development of diagnostic and therapeutic techniques (such as ART techniques) and the immersion of new pathologies (such as COVID19), we are witnessing an increase in the incidence of pathologies that were previously described as rare or exceptional. the practitioner sometimes confronts difficult situations in these cases in diagnostic ...read more
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