A woman had a previous classical (vertical body) cesarean section at 28 weeks for abruptio placentae. She is now pregnant at 38 weeks. What is the recommended timing and mode of delivery?
- A Elective repeat cesarean section at 36–37 weeks before onset of labour ✓
- B Trial of labour at 39 weeks is safe as uterine healing after a classical incision is equivalent to lower-segment
- C Elective repeat cesarean section at 39 weeks with pre-labour assessment
- D Induction of labour at 38 weeks followed by intensive monitoring
Correct answer: A. Elective repeat cesarean section at 36–37 weeks before onset of labour
Explanation
Classical (upper uterine body) cesarean incision carries a significantly higher risk of uterine rupture (4–9%) compared to lower uterine segment cesarean (0.5–1%), and rupture often occurs before the onset of labour or early in pregnancy. Therefore, delivery is recommended at 36–37 weeks by elective repeat cesarean, before spontaneous labour begins. Trial of labour after classical cesarean (TOLAC) is absolutely contraindicated. Waiting until 39 weeks risks spontaneous onset of labour with risk of catastrophic rupture.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.