A G2P1 with one prior uncomplicated lower segment transverse cesarean for breech presentation is counseled about trial of labor after cesarean. She will labor spontaneously at term. Approximately what is her risk of symptomatic uterine rupture during labor?
- A 2 to 4 percent
- B Less than 1 percent (about 0.5 percent) ✓
- C 5 to 9 percent
- D 12 to 15 percent
Correct answer: B. Less than 1 percent (about 0.5 percent)
Explanation
With a single prior low transverse scar and spontaneous labor, symptomatic uterine rupture occurs in roughly 0.5 to 0.9 percent of cases, under 1 percent, which forms the basis for offering TOLAC. The 4 to 9 percent range approximates rupture risk with one prior classical or unknown-vertical scar, and figures rise further with two prior scars, killing options A through D. Augmentation with oxytocin modestly increases risk, while prostaglandins and misoprostol are avoided after a previous cesarean.
Reference: ACOG Practice Bulletin No. 205: Vaginal Birth After Previous Cesarean Delivery, 2019 ed.
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Written and medically reviewed by the StethoPrep medical team.