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Management of Previous unknown Cesarean scarFrom: Garry E. Siegel (garrys@atl.mindspring.com)Thu Aug 29 19:15:24 1996
On 8/29/96, 1703, Cheri asked about management of a 36 YO G3P2 with 2 previous unknown scars, from Cesareans in Mexico. She also asked specifically about amnioinfusion (if indicated) and pitocin (if indicated). There are several issues to address. Firstly, and perhaps most importantly, should you elect to labor her, you will have no leg on which to stand should a mishap occur, at least from a medico-legal perspective. I recall an article in the not too distant past concerning the exact issue, but I cannot cite it. I believe the conclusion was that you could safely labor someone with one previous unknown incision, and that the study (retrospective, of course) didn't have enough numbers to comment on 2 unknown incisions. However, since the incidence of uterine rupture, and other catastrophic outcomes is quite low, it seems as though it would take a large number of patients to prove that it is safe. Should you attempt to labor her, I think it is fair to say that the management of VBACs is not that different from routine labors. Specifically, if you choose to labor this individual, then to withhold pitocin and/or amnioinfusion when these are indicated makes little sense, if you have chosen to labor her. I hope my $.02 is helpful--I'm just a regular old ob-gyn out here in the real world.
-- Garry E. Siegel, M.D. Roswell, Ga.
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