POST C/S TERM PREGNANCY
Presented by-
Roll No. :- 41,42,43,44
CONTENTS
• Introduction
• Effect of pregnancy on labour
• Selection of Delivery Route
• TOLAC
• ERCD
• Management
INTRODUCTION
• The occurrence of pregnancy after a cesarean section, however, is not
always devoid of danger, cases have been reported in which the uterine
cicatrix rupture in the later part of a subsequent gestation. It is always
stated, the adhesions that sometimes form between the uterus and the
abdominal wall occasionally exert a deleterious influence in subsequent
pregnancy.
- J.WHITRIDGE
WILLIAMS(1903)
EFFECT OF PREGNANCY ON
LABOUR
• Abortion
• Preterm labour
• Normal pregnancy ailments
• Operative interference and incidental morbidity
• Placenta Previa
• Placenta Accreta
• Post partum haemorrhage
• Peripartum hysterectomy
• Need of repeat cesarean delivery
• Increase risk of scar rupture
CASE
• A G2P1L1 women is seen in opd at 37 weeks of gestation with prior
cesarean section. She is concerned whether she can deliver vaginally
this time?
• These are the points which need to be known to help her make the
decision:-
How many caesarean section ?
How long ago was her caesarean delivery?
What was the reason for caesarean?
At what gestation was the caesarean done?
Any history of wound infection?
Present pregnancy characteristics?
SELECTION OF DELIVERY ROUTE
• TOLAC(Trial of Labour After Cesarean)
• Elective Repeat Cesarean Delivery
• If there is failed trail of labour we can do a repeat cesarean section.
TOLAC
• Maternal Risk
1.Uterine Rupture
a) Complete: when all the layers of the uterine wall are separated
b)Incomplete: when the uterine muscle is separated but the visceral
peritoneum is intact. It is also known as uterine dehiscent.
The incidence pf scar rupture is about 0.2 to 1.5% in previous LSCS and
about 4 to 9 % in classical or hysterotomy scar
FETAL AND NEONATAL RISK
• TOLAC is associated with significantly higher perinatal mortality rates
compared to ERCD
• Higher risk of hypoxic ischemic encephalopathy
• Transient tachypneoa of newborn
SELECTION CRITERIA OF CASES
FOR TOLAC
• One(RCOG) or two (ACOG) previous lower segment tranverse scar
• Nonrecurring indication for prior caesarean section
• Pelvis adequate for the fetus
• Continued labour monitoring possible
• Availability of resources(anesthesia, blood transfusion and theatre) for the
emergency caesarean section within 30 minutes of decision
• Informed consent of the woman
PRIOR UTERINE INCISION
1. Prior incision type
CONTD.
2. Prior incision closure
3.No. of prior cesarean incision
4. Imaging of prior incision
5. Prior uterine rupture
6. Interdelivery interval [ more than equal to 18 month]
7. Prior vaginal delivery
8. Prior cesarean delivery indication
9. Fetal size and lie
10. Multifetal gestation
11. Maternal obesity
12.Fetal death
CONTRAINDICATION FOR TOLAC
• Previous classical or inverted T- shaped uterine incision
• Previous >2 LSCS
• Pelvis contracted or suspected CPD
• Presence of other complication of pregnancy:
Obstetric: preeclampsia , malpresentation, placenta previa
medical
• History of prior uterine rupture
• Resources limited for emergency cesarean delivery or patient refusal for
TOLAC
TOLAC BENEFITS AND RISK
COMPLICATION
TIMING OF DELIVERY FOR ERCD
Should be done after 39 completed week
And before 40 weeks
As the fetus will be matured at that time
MANAGEMENT
REFERENCE
• WILLIAMS OBSTETRICS
• DC DUTTA’S TEXTBOOK OF OBSTETRICS
