A patient with a previous classical cesarean section (vertical uterine incision) presents at 38 weeks. She desires a vaginal delivery. What is the most appropriate management regarding trial of labor?

• A Trial of labor is recommended as the scar is low risk
• B Trial of labor is contraindicated; schedule cesarean at 39 weeks
• C Trial of labor is allowed only if oxytocin is avoided
• D Trial of labor is contraindicated; schedule cesarean at 36-37 weeks ✓

Explanation

Classical (vertical) uterine incision is an absolute contraindication to trial of labor because of the high risk of uterine rupture (4 to 9 percent) during labor. Elective repeat cesarean is recommended at 36 to 37 weeks before the onset of labor to minimize rupture risk. This differs from low transverse scar where TOLAC is offered. The classical incision involves the upper contractile segment of the uterus, which is more prone to rupture under labor forces.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.