T C-section

[jme24]

10 years go, i had a c-section with a "T" cut. Horizontal on the outside and vertical on the uterus. I am pregnant with my second child. Am i able to deliver without rupture?

[Ms. B. Sprout]

There is no way to identify beforehand who will rupture. There will be a percentage risk of rupture for a vertical scar. You and your care provider will have to hash it out.

ACOG's Practice Bulletin 115 "allows" trial of labor for women with unknown scar types. Not sure about vertical -- I can't put my hands on the actual Bulletin right now (it's on my DH's work computer), only this press release describing it. If I recall correctly, I don't think vertical scars were included in the revised position.

The NIH VBAC Consensus Statement addresses vertical incisions only in general terms:

Women with classical and low vertical uterine scars have an increased risk of rupture when compared to women who had a low transverse uterine incision at the time of cesarean delivery.

Perhaps there is a good number out there for vertical-scar rupture risk, but I don't know it. 

[labortrials]

I know there are 'special scar' support groups out there.  Try an internet search and you should find them.

[AlexisT]

The issue with vertical scars is how far up they go--a low vertical is much safer than a classical, so I would think that the size of the vertical part of the T is crucial here. If it extends into the upper segment, you'd be hard pressed to find an OB who would do it. If you had or could get any more information on how the incision was done, that would probably be helpful for your decision.

The stats aren't great. They tend to be old, because OBs don't want to deliver non-transverse incisions. It's definitely higher for a classical incision because the muscle in the upper segment is more active during labor, and the research definitely supports the idea that rupture is more frequent with these incisions--we just don't have the best figures on how much higher. The question is not "can you deliver without rupture?" because even the worst case stats on rupture with non-transverse scars is a 9% rupture rate, and uterine rupture is a possibility, albeit a rare one, in any labor. (To be clear: I am not saying this is the best set of statistics, but rather, the worst figure that is commonly reported.) The best case scenario is 1.9% for inverted T (Landon 2004), vs. 0.5% for single LSCS. Even the worst case gives you a 91% chance of not rupturing. The question is, "Does the risk of fetal death or major injury from rupture outweigh the risks of planned cesarean section?" Both courses of action have risks; they always do.

[jessica_anne010]

Hello!
 

Originally Posted by jme24 

10 years go, i had a c-section with a "T" cut. Horizontal on the outside and vertical on the uterus. I am pregnant with my second child. Am i able to deliver without rupture?

Technically that isn't a T, just a vertical cut.  The T is when there is a vertical and horizontal cut both on the uterus.  :-)  Have you read your surgical report?  If your's is a low vertical there is NO increased risk of rupture according to the Shipp study which you can find on the Special Scars website - http://specialscars.org/articles/index.html.  If it is a Classical (higher vertical) then your risk of rupture is about 1.9%.  The fact that your cesarean was 10 yrs ago raises your odds for a successful VBAC dramatically.  :-)  I had a VBAC 7 yrs after my Inverted T incision which was 8 cm long and "extended well into the fundus".  The vertical portion of my scar was near to what most docs call a Classical.  Please come join our Yahoo group or the Facebook group.  There have been several mommas who VBAC'd after classical scars just in the last year and their babies are much closer in age than yours.  :-)  The links to the groups are on the Links page, under Support.  When you join either, just remind me that you posted here and I'll add you to the groups immediately.

Good luck!

[GOPLawyer]

IIRC, the study that showed a rupture rate of around 10 or so percent (I don't recall the exact stat) included dehiscences (windows) in the rupture group so that study isn't a true picture of the risk.  Unfortunately, in the *many* doctors I spoke with, that seems to be the study that OBs like to quote.

Have you found an OB or MW that will attend?  I dealt with *many* and they seemed to consider me some sort of ticking time bomb (I have a similar J incision that went up into the contractile portion of the uterus).

In looking at the research out there, I always considered the risk to be somewhere around 1-2%.  Considering that means that there is a 98-99% chance that no rupture is going to happen...I felt pretty comfortable.  I was actually planning a homebirth w/ a MW.  It turned into a hospital birth @ 30 weeks.  The OBs were trying to bully me into a c/s.  I flat out refused and went on to have a wonderful VBA2C w/ a J incision.

Check out this website on special scars.