Rupture of the scarred uterus

Although theoretically important, the bulk of obstetric literature indicates that scar separation following a lower transverse uterine incision is not a significant problem in clinical obstetrics. The need for emergency intervention for such scar separation is not increased over that in any laboring patient for a number of other causes. Ideally, the capability of emergency intervention should be available for any laboring patient. In reality, however, such a situation will not commonly be present in all hospitals in the United States. The absence of in-house anesthesia coverage does not appear to be a valid reason to exclude the carefully informed patient from a trial of labor following a previous low transverse uterine incision. Not only is scar separation infrequent, but maternal and perinatal morbidity should be negligible when such scar separation does occur. The use of oxytocin and epidural anesthesia appears to be appropriate. The latter does not mask signs or symptoms of scar separation. Because most scar separation will be heralded by the appearance of variable decelerations, extremely careful fetal heart-rate monitoring is mandatory for any patient laboring with a previous uterine incision. Finally, the detection of an asymptomatic scar separation after successful vaginal delivery in a nonbleeding patient does not appear to mandate repair. However, the uncertainties regarding the method of delivery for future pregnancies should be carefully explained to such patients if nonrepair is elected.