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Vaginal Birth After Cesarean Delivery (cont.)

Types of Uterine Incisions

For women who have had cesarean deliveries, a vaginal delivery in later pregnancies is often possible, depending on the type of incision that was made and the reason for the cesarean delivery. That is why it is so important for the doctor to have the medical records relating to the previous cesarean delivery. Hysterotomy is the medical term for incision of the uterus.

There are three types of uterine incisions.

  • The "classic hysterotomy" is a type of incision that was once common in which a high vertical (up and down) cut was made. This type of incision is associated with a higher rate of uterine rupture, and a repeat cesarean delivery would be recommended.
  • A low vertical hysterotomy is like a classic hysterotomy incision, except that it is made lower on the abdomen. Some studies have indicated less risk of uterine rupture with a low vertical incision than with a high vertical incision.
  • Today, most babies who are delivered by cesarean are delivered through a low transverse (side-to-side) incision, at or below the bikini line. This type of incision is considered to have the lowest risk of uterine rupture.

The direction of the first incision on the skin (up and down or side to side) does not necessarily match the direction of the next incision made in the uterus.

A vertical incision on the uterus may be used for delivering preterm babies, babies with abnormally positioned placentas, pregnancies with more than one fetus, and in extreme emergencies. These incisions are considered an outright indication for a repeat cesarean delivery.

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