A 30-year-old primigravida with a previous classical (vertical) cesarean section presents at 37 weeks. She desires a trial of labour. What is the recommended management?
- A Offer TOLAC as she has only one prior uterine scar
- B Advise elective repeat cesarean at 36-37 weeks before labour ✓
- C Advise elective repeat cesarean section at 39 weeks
- D Offer induction with dinoprostone for cervical ripening
Correct answer: B. Advise elective repeat cesarean at 36-37 weeks before labour
Explanation
A previous classical uterine incision carries a 4-9% risk of uterine rupture in labour, substantially higher than the 0.5-1% risk with a low transverse scar. ACOG and RCOG recommend against TOLAC with a prior classical incision and advise elective repeat cesarean section before labour, typically at 36-37 weeks (after confirming lung maturity or per institutional protocol). Dinoprostone and TOLAC are both contraindicated.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.