Previous cesarean section

1. Previous Cesarean Section
Dr P.Pallavee

2. • A 28 yr old G2P1L1 at 39 wks gestation with
history of previous caesarean section comes
to OPD with complaints of pain abdomen.
• Identify the risk in the patient.

3. Objectives
• Define the terms Caesarean
section/ERCS/TOLAC
• Describe the effect of prior caesarean section
on present pregnancy .
• Assess the integrity of scar to decide mode of
delivery.

4. Understand the terms…..
• Caesarean section [ LSCS/ CLASSICAL]
• Post caesarean pregnancy
• Primary caesarean section
• ERCS[ Elective repeat caesarean section]
• TOLAC/VBAC

5. What is the risk?
• Abortion
• Preterm labour
• Placenta praevia
• Adherent Placenta
• PPH
• Peripartum hysterectomy
• Scar rupture

6. Which scar is sound?

7. LSCS CLASSICAL
Apposition More perfect Difficult to appose as
thicker musculature
Healing Part of uterus remains
inert
Part contracts/retracts
Stretching effect Along the line of scar At right angles
Scar rupture 0.2% 4-9%
Mortality less more

8. Mode of delivery
• Once a caesarean always a caesarean?
• Classical caesarean/ hysterotomy ERCS
• LSCS ERCS?
TOLAC?
ASSESS SCAR INTEGRITY

9. Integrity of scar
• Factors to consider:
• Previous operative notes
• Defect in scar in inter-pregnancy interval
• Short inter-pregnancy interval
• Pregnancy complications[ twins/ polyhydramnios]
• Previous vaginal delivery.
Indication of previous CS
Extension of the uterine
incision
Puerperal sepsis

10. Management of post caesarean
pregnancy.
• Manage as high risk
• Elective hospitalisation
 36 wks- classical CS/ hysterotomy
 38 wks-LSCS
• Mode of delivery
 Classical CS/ other extensions– ERCS[ 38 wks]
 LSCS– Individualise
----ERCS at 39 wks
---- TOLAC[spontaneous/induction]

11. References
• DC Dutta textbook of obstetrics.

12. THANK YOU.