Managing Complications in Pregnancy and Childbirth: - IAWG

S-94 Labour with a scarred uterus- The fetus is in a normal vertex presentation;- Emergency caesarean section can be carried out immediately ifrequired.• If these conditions are not met or if the woman has a history of twolower uterine segment caesarean sections or ruptured uterus,deliver by caesarean section (page P-43).• Monitor progress of labour using a partograph (page C-65).• If labour crosses the alert line of the partograph, diagnose thecause of slow progress and take appropriate action:- If there is slow progress in labour due to inefficient uterinecontractions (Table S-10, page S-57), rupture the membraneswith an amniotic hook or a Kocher clamp and augment labourwith oxytocin (page P-17);- If there are signs of cephalopelvic disproportion or obstruction(Table S-10), deliver immediately by caesarean section (pageP-43).• If there are signs of impending uterine rupture (rapid maternalpulse, persistent abdominal pain and suprapubic tenderness, fetaldistress), deliver immediately by caesarean section (page P-43).• If uterine rupture is suspected, deliver immediately by caesareansection (page P-43) and repair the uterus (page P-95) or performhysterectomy (page P-103).