Which scenario is a recognized risk factor for uterine rupture?

Which scenario is a recognized risk factor for uterine rupture?

• A. Trial of labor after cesarean (TOLAC)
• B. Elective repeat cesarean without prior scar
• C. Spontaneous vaginal birth after cesarean with no scar
• D. First pregnancy with no prior uterine surgery

Answer: (A)

The key idea is that uterine rupture most strongly arises when a scar from a previous cesarean is subjected to labor. A trial of labor after cesarean means attempting vaginal birth after having had a cesarean before. The scar tissue in the uterus is weaker than normal tissue, and the strong, sequential contractions of labor can cause the scar to give way, leading to a rupture that endangers both mother and baby. This is a recognized risk factor precisely because labor pushes on the uterine scar. In contrast, pregnancies without any prior uterine surgery involve no scar, so the risk of rupture during labor is much lower. A planned cesarean before labor avoids the stresses of labor on a scar, and a first pregnancy with no prior uterine surgery has no scar to be stressed, so those scenarios do not carry the same rupture risk.

The key idea is that uterine rupture most strongly arises when a scar from a previous cesarean is subjected to labor. A trial of labor after cesarean means attempting vaginal birth after having had a cesarean before. The scar tissue in the uterus is weaker than normal tissue, and the strong, sequential contractions of labor can cause the scar to give way, leading to a rupture that endangers both mother and baby. This is a recognized risk factor precisely because labor pushes on the uterine scar.

In contrast, pregnancies without any prior uterine surgery involve no scar, so the risk of rupture during labor is much lower. A planned cesarean before labor avoids the stresses of labor on a scar, and a first pregnancy with no prior uterine surgery has no scar to be stressed, so those scenarios do not carry the same rupture risk.