Malpresentations and Positions & Operative Obstetrics
Trial of scar is contraindicated in all except: (AIIMS Nov. 2012)
|A||History of previous classical CS|
|B||History of previous CS due to contracted pelvis|
|C||previous 3 LSCS|
|D||History of previous LSCS due to malpresentation|
History of previous LSCS due to malpresentation
a. A patient of previous LSCS attempting a vaginal delivery is called a trial of scar (as the previous scar is put to trial).
b. Trial of scar is absolutely contraindicated in CPD.
c. In case of previous classical CS the risk of rupture uterus during trial is 4-9 % & hence trial of scar is not attempteD.
d. Recommendations Useful for the Selection of
e. Candidates for Vaginal Birth after Cesarean Delivery
f. No more than one prior low-transverse cesarean delivery
i. Clinically adequate pelvis (no CPD)
ii. No other uterine scars or previous rupture
iii. Physician immediately available throughout active labor who is capable of monitoring labor and performing emergency cesarean delivery
iv. Availability of anesthesia and personnel for emergency cesarean delivery
g. The success rate for a trial of scar depends to some extent on the indication for the previous cesarean delivery. Generally, about 60–80% of trials after prior cesarean birth result in vaginal delivery, with success being maximum
h. if previous cesarean section was because of breech presentation.