Regarding the trial of labour after caesarean (TOLAC), which single factor most significantly increases the risk of uterine rupture compared to a repeat elective caesarean section?

• A Prior low-transverse uterine incision
• B Inter-delivery interval of less than 18 months ✓
• C Single-layer uterine closure at previous caesarean
• D Epidural analgesia masking rupture pain during TOLAC

Explanation

An inter-delivery interval of less than 18 months (some studies cite <24 months) after caesarean section is the single most important modifiable factor significantly increasing uterine rupture risk during TOLAC (RR approximately 3-fold). The prior low-transverse incision is associated with the lowest rupture risk among uterine scar types (~0.5–0.9%). Single-layer closure has a trend toward higher rupture but evidence is conflicting. Epidural does not mask the signs of rupture in most cases.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.