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Vaginal Birth After Cesarean Delivery (cont.)

What are the types of uterine incisions with C-sections?

For women who have had C-sections, a vaginal delivery in subsequent pregnancies is often possible, depending on the type of incision that was made on the uterus and the reason for the initial C-section. This information is available from the medical records of their initial C-sections. Hysterectomy is the general medical term for an incision into the uterus.

There are three types of uterine incisions.

  1. A classical incision wherein a deep vertical incision is made through the thick upper portion of the uterine wall. Although seldom used today, this incision may occasionally be necessary if the fetus is found to be in an unusual position; with twins or premature infants; and in the case of placenta previa. This type of incision is associated with a higher likelihood of uterine rupture during subsequent pregnancies, and any decision to attempt VBAC should be discouraged.
  2. A low vertical incision, which is similar to a classical incision except that it is made lower on the uterine wall. Some studies have indicated a lower risk of uterine rupture with a low vertical incision than with a classical incision. Again, with this type of incision, a repeat C-section is preferred to VBAC with subsequent deliveries.
  3. A low transverse incision, wherein the lower uterine wall is entered horizontally in an area where the uterine wall is thinner, and there is usually less bleeding. This is the type of incision that is most commonly used in obstetrical practice today. In most cases in which this incision has been used, VBAC may be attempted, but close monitoring of both mother and fetus is imperative.

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

Medically Reviewed by a Doctor on 4/1/2016
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