Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement

A cesarean section is a surgical procedure that is used to deliver an infant who cannot be delivered vaginally. The surgery involves making an incision in the mother's abdomen and into the uterus so that the baby can be removed. Following delivery, the uterus begins to heal and a scar forms over the area were the incision was made. Over the last several decades, the number of babies delivered by cesarean section has increased dramatically. In the past, women who underwent cesarean sections were recommended to have all subsequent babies delivered by cesarean section as well. This was recommended because it was thought that the contractions of the uterus that occur during a normal labor during vaginal delivery would cause the scar on the uterus to rupture. Symptoms of scar rupture include abnormal fetal heart rate, vaginal bleeding, and pain. In recent years, several studies have shown that women who undergo a cesarean section can subsequently have a normal labor by vaginal delivery, and that rupture of the scar in the uterus is not a common occurrence. It has been suggested that close monitoring of changes in pressure within the uterus during labor (uterine activity) may be useful in protecting against rupture of the scar. Of the women examined, vaginal delivery was achieved without scar rupture in 65 percent. However, out of 10 cases of uterine scar rupture that were examined in detail, six scar ruptures occurred even though uterine activity was within the normal range. It is concluded that measuring changes in pressure within the uterus during labor does not safeguard against scar rupture. (Consumer Summary produced by Reliance Medical Information, Inc.)