with scarred uterus
Start an IV infusion and infuse IV fluids.
If possible, identify the reason for the uterine scar. Caesarean section and other uterine surgeries (e.g. repair of a previous uterine rupture, excision of an ectopic pregnancy
implanted in the cornua) leave a scar in the uterine wall. This scar can weaken the uterus, leading to uterine rupture during labour (Box S-6).
BOX S-6 Rupture of uterine scars
Vertical scars from a previous caesarean section may rupture
before labour or during the latent phase.
Transverse scars typically rupture during active labour or during
the expulsive phase.
The rupture may extend only a short distance into the myometrium with
little pain or bleeding. The fetus and placenta may remain in the uterus and the fetus may survive for minutes
Studies have shown that some 50% of cases with low transverse caesarean scars can deliver vaginally. The frequency of rupture of low transverse scars during a careful trial of
labour is reported as less than 1%.
TRIAL OF LABOUR
- The previous surgery was a low transverse caesarean incision;
- The fetus is in a normal vertex presentation;
- Emergency caesarean section can be carried out immediately if required.
conditions are not met or if the woman has a history of two lower uterine segment caesarean sections or ruptured
uterus, deliver by caesarean section.
Monitor progress of labour
using a partograph.
labour crosses the alert line of the partograph, diagnose the cause of slow progress and take appropriate action:
- If there is slow progress in labour due to inefficient uterine contractions
S-10), rupture the membranes with an amniotic hook or a Kocher clamp and
augment labour with oxytocin;
- If there are signs of cephalopelvic disproportion or obstruction
S-10), deliver immediately by caesarean section.
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