From the Research
The maximum allowable extent of uterine scar extension for permitting vaginal delivery in a subsequent pregnancy is generally considered to be less than 2 cm, based on the most recent and highest quality evidence available 1. When considering vaginal birth after cesarean (VBAC), the size and location of any uterine scar extension are critical factors in assessing the risk of uterine rupture during subsequent labor.
- The location of the tear is also important, with lateral tears tend to be less concerning than those extending vertically downward from the uterine incision.
- For women with extended tears beyond 2 cm, the risks and benefits of future VBAC should be carefully evaluated on an individual basis, taking into account the potential for increased risk of uterine rupture and other complications.
- Proper identification and repair of any extended tear with absorbable sutures is essential to minimize complications and ensure the best possible outcomes for both mother and baby.
- Documentation of any extended tear in the operative report is crucial for future pregnancy planning and counseling, allowing healthcare providers to make informed decisions about the safest course of care for each individual patient 2, 3, 4, 5, 1.