In trial of labor after cesarean (TOLAC), which factor carries the HIGHEST risk for uterine rupture during labor?

• A One prior low transverse uterine incision
• B Induction with prostaglandins (misoprostol) in a scarred uterus ✓
• C Induction of labor with oxytocin alone
• D Labor at 39 weeks gestation after 18-month interpregnancy interval

Explanation

The highest modifiable risk factor for uterine rupture during TOLAC is use of prostaglandins (especially misoprostol/PGE1) for cervical ripening or induction in women with a prior uterine scar. Prostaglandin use is generally contraindicated or used with extreme caution in TOLAC because it increases uterine contractility in a fashion difficult to control, with rupture risk 2–5 times higher than spontaneous labor. Oxytocin alone carries a significantly lower rupture risk (~0.9%). A previous low transverse incision and adequate interpregnancy interval are the baseline acceptable scenario for TOLAC.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.