NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)
This is a maternal obstetric history record of a prior delivery by C-section. In primary care, evaluate uterine scar integrity, inter-pregnancy interval, and prior surgical indications when planning subsequent pregnancies. Advise antenatal care registration early in any future pregnancy to assess suitability for trial of labour after caesarean (VBAC) versus elective repeat C-section. - Refer
Adult-only condition - paediatric section not applicable
No dose - referral pathway, no medicine given in primary care
This is a maternal obstetric history record of a prior delivery by C-section. In primary care, evaluate uterine scar integrity, inter-pregnancy interval, and prior surgical indications when planning subsequent pregnancies. Advise antenatal care registration early in any future pregnancy to assess suitability for trial of labour after caesarean (VBAC) versus elective repeat C-section.
- None specific; relevant mainly for assessing the risk of uterine scar complications in a future pregnancy.
- No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
- Whether a woman with a previous caesarean can attempt labour next time depends on the type of uterine incision: a previous vertical (classical) or T incision means the next delivery must be by caesarean.
- A classical (vertical) hysterotomy rules out a trial of labour in future pregnancies because of the heightened risk of uterine rupture.
- RED FLAG - Do not use misoprostol for cervical ripening in a woman with a previous caesarean and an unfavourable cervix at term - it increases the risk of uterine rupture.
- A previous classical caesarean, or any history of uterine rupture, is itself an indication for caesarean delivery next time.
- The risk of placenta accreta rises with the number of previous caesareans, and is already about 0.3% after a single one - so ask about caesarean count when planning antenatal care.
- A morbidly adherent placenta risks major haemorrhage and may cost the woman her fertility if hysterectomy becomes necessary.
- Adhesions build up with each caesarean, making every subsequent operation harder and raising the risk of inadvertent injury.