Managing Complications in Pregnancy and Childbirth: - IAWG

LABOUR WITH A SCARRED UTERUS S-93PROBLEM• A woman in labour has a scarred uterus from a previous uterinesurgery.GENERAL MANAGEMENT• Start an IV infusion and infuse IV fluids (page C-21).• If possible, identify the reason for the uterine scar. Caesareansection and other uterine surgeries (e.g. repair of a previous uterinerupture, 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-6Rupture of uterine scars• Vertical scars from a previous caesarean section may rupture beforelabour or during the latent phase.• Transverse scars typically rupture during active labour or during theexpulsive phase.• The rupture may extend only a short distance into the myometriumwith little pain or bleeding. The fetus and placenta may remain in theuterus and the fetus may survive for minutes or hours.SPECIFIC MANAGEMENTStudies have shown that some 50% of cases with low transversecaesarean scars can deliver vaginally. The frequency of rupture of lowtransverse scars during a careful trial of labour is reported as less than1%.TRIAL OF LABOUR• Ensure that conditions are favourable for trial of labour, namely:- The previous surgery was a low transverse caesarean incision;