ROUTINE REVISION OF UTERINE SCAR AFTER CESAREAN-SECTION - HAS IT EVERBEEN NECESSARY

Although a trial of labor after cesarean section (VBAC) is successful and relatively safe, few studies have directly addressed the necessity of routine transcervical revision of uterine scar after prior cesarea n section. We performed a longitudinal study of 3469 women who had VBA C. In all patients, uterine scar integrity was examined immediately af ter placental expulsion. The detection rate of uterine scar dehiscence or rupture was 0.23% (8/3469). Only one woman with complete uterine r upture needed immediate laparotomy for severe hemorrhage. Out of seven patients (0.2%), who had evidence of uterine dehiscence, three underw ent explorative laparotomy. In conclusion, the potential benefit of ro utine examination of uterine scar after VBAC is doubtful. Transcervica l revision should be performed only in symptomatic patients. (C) 1998 Elsevier Science Ireland Ltd.