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Routine revision of uterine scar after prior cesarean section
1Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah-Tikva, Israel.
Up until the early seventies fear of uterine rupture led to the widespread practice of 'once a section, always a section'. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However, the need for routine transcervical revision of the uterine scar following vaginal delivery is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2 vaginal tablets were used in 46 patients, and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary.
Up until the early seventies fear of uterine rupture led to the widespread practice of 'once a section, always a section'. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However, the need for routine transcervical revision of the uterine scar following vaginal delivery is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2 vaginal tablets were used in 46 patients, and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary.
