A patient with one previous lower segment cesarean section presents at 39 weeks requesting a trial of labor (TOLAC). Her previous cesarean was for non-recurrent indication. The factor that MOST SIGNIFICANTLY increases the risk of uterine rupture in TOLAC is:

• A Previous uterine rupture or classical cesarean scar ✓
• B Short inter-delivery interval of less than 18 months
• C Advanced maternal age (>35 years)
• D Obesity (BMI >30)

Explanation

Previous uterine rupture (any) or classical (vertical) cesarean scar carries a uterine rupture risk of 4–9% with TOLAC, which is prohibitively high; TOLAC is absolutely contraindicated with these scar types. Lower segment transverse scar TOLAC rupture risk is 0.5–1%. Short inter-delivery interval (< 18–24 months) increases risk approximately 3-fold and is a relative contraindication. Obesity and age independently increase operative risk but are not the most significant independent risk factors for rupture specifically. Previous classical or T-incision is the highest-risk factor for TOLAC uterine rupture.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.