A 33-year-old G2P1 with a previous lower segment cesarean section presents in spontaneous labour at 39 weeks. Her previous cesarean was for non-recurrent indication. She is keen for VBAC. A contraindication to a trial of labour after cesarean (TOLAC) in this patient would be:
- A Previous one lower segment cesarean section only
- B Gestational age of 39 weeks
- C Previous classical (upper segment) uterine incision ✓
- D Multiparous status (G2P1)
Correct answer: C. Previous classical (upper segment) uterine incision
Explanation
A previous classical (vertical, upper uterine segment) cesarean incision is an absolute contraindication to TOLAC because the risk of uterine rupture is 4–9%, far higher than for a lower segment scar (~0.5–1%). Other contraindications include prior uterine rupture, prior myomectomy entering the endometrial cavity, and more than two previous cesareans. A single prior lower segment CS with a non-recurrent indication is the ideal candidate for TOLAC, with vaginal birth rates of 60–80%. Multiparous status is actually a favourable factor for VBAC success.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.