The document discusses risks and management considerations for a woman who is pregnant again after a previous Cesarean section. It defines terms like Cesarean section, ERCS, VBAC, and TOLAC. It notes risks in the current pregnancy like abortion, preterm labor, and scar rupture. It explains that classical Cesarean scars are more difficult to appose than lower segment scars. The integrity of the scar must be assessed to determine whether a trial of labor is possible or an elective repeat Cesarean section is required based on factors like the previous surgery, complications, and interval since the last pregnancy. Management includes elective hospitalization from 36 weeks for classical scars or 38 weeks for lower segment sc

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.