In the management of a woman with a previous classical (vertical) caesarean section scar who presents in spontaneous labour at 36 weeks, the correct management is:

• A Allow trial of labour — classical scars rupture mainly in the third trimester, not during labour
• B Expectant management until 37 weeks then elective caesarean
• C Oxytocin augmentation is safe provided electronic fetal monitoring is continuous
• D Emergency caesarean section immediately as classical scar uterine rupture in labour carries high risk ✓

Explanation

Classical (vertical, corporal) caesarean section scars carry a much higher risk of uterine rupture than lower segment scars — approximately 4–9% compared to 0.5–1% for LSCS. Classical scars are prone to rupture both in the third trimester and during active labour. The standard of care is elective repeat caesarean at 36–37 weeks (before spontaneous labour onset). If a woman with a classical scar presents in established labour, emergency caesarean is performed immediately given the very high rupture risk.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.