Re: VBAC, Three previous CS.

From: Luis Sanchez-Ramos, MD (sanchez-ramos@worldnet.att.net)
Sun Jan 30 14:05:43 2000

At Sun, 30 Jan 2000, Robert J. Carpenter, Jr., M.D. wrote:

>>The article is Leung, Leung, Paul, should be 10/93 in the AJOG<<

--
Luis Sanchez-Ramos, MD  wrote:


>>Nonetheless, the rate quoted from USC seems high.  Many patients at USC had a trial of labor with "unknown" scars, many of which were classical cesarean operations performed in Latin America<<


As I previously stated, the study population at USC consisted largely of
indigent Hispanic women with an unknown uterine scar.In fact, by history
90% had unknown uterine scars.
Leung's retrospective,study covering 10 years, included 11,179 patients
who attempted a VBAC.  Of these, 214 had at least 3 prior cesarean
deliveries.Of these 214 patients, 6 experienced a ruptured
uterus(2.8%)However,these patients (n=6) all had acute fetal distress on
arrival and were delivered immediately by cesarean.In addition, all of
them had either a prior classical cesarean or an unknown scar.
As can be seen, one cannot generalize and reliably estimate a 2.8%
incidence of uterine rupture for patients with at least 3 previous
cesarean deliveries.  I would imagine that the incidence would be much
less if one considers patients with only low transverse incisions who do
not present with acute fetal distress and with unsupervised labor of
indeterminate duration.


Luis Sanchez-Ramos, MD



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