In the assessment of a uterine scar for trial of labour after caesarean (TOLAC), the single most important contraindication to TOLAC according to ACOG 2019 Practice Bulletin is:
- A Inter-delivery interval less than 18 months
- B Estimated fetal weight greater than 4000 g
- C Previous classical (vertical) uterine incision or T-incision ✓
- D More than one prior caesarean section
Explanation
ACOG 2019 Practice Bulletin 205 lists as contraindications to TOLAC: previous classical (high vertical) uterine incision, T- or J-shaped uterine incision, prior uterine rupture, or a situation in which immediate emergency surgery cannot be performed. Classical incision carries uterine rupture risk of 4–9% — far higher than the 0.5–0.9% risk with low transverse scar. Inter-delivery interval <18 months increases rupture risk but is not an absolute contraindication. EFW >4 kg and multiple prior caesareans are relative contraindications that modify counselling but do not absolutely prohibit TOLAC in all cases.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.