Vaginal birth after cesarean delivery.

Abstract

sis may be difficult because of the variable presentation and degree of scar separation, fetal bradycardia is present in nearly 70% of cases and may be preceded by a nonreassuring fetal heart rate tracing. Fetal bradycardia is the most common sign of uterine rupture; other signs and symptoms include abdominal pain (7–10%), vaginal bleeding (3–5%), hemodynamic instability (5–10%), and recession of presenting part ( 5%) (fig. 1). 10 Although pain is not often associated with uterine rupture, some patients will complain of varying and/or upper abdominal pain resulting from blood and amniotic fluid produced by diaphragmatic irritation. The classic symptoms (i.e., hypotension, fetal bradycardia, loss of contractions measured by intrauterine pressure catheterization, atypical abdominal pain, and vaginal bleeding) are present in only 17% of cases. 10 Uterine dehiscence refers to a subclinical separation of a previous uterine incision and is often, but not always, asymptomatic. Although transverse uterine scars are assumed to be safer and less vascular than classic uterine scars, delayed diagnosis and treatment of transverse scar rupture can still result in serious maternal and fetal complications.