Indication of caesarean section after previous caesarean section is?
**Core Concept**
A previous uterine incision from a previous Caesarean section (CS) can lead to increased risks during subsequent pregnancies, including uterine rupture, placenta accreta, and fetal distress. The American College of Obstetricians and Gynecologists (ACOG) recommends a planned repeat CS for women with a history of previous CS, especially if the previous uterine incision was a low-transverse incision.
**Why the Correct Answer is Right**
A planned repeat CS is recommended for women with a history of previous CS due to the increased risk of uterine rupture. This is because a previous uterine incision can weaken the uterine wall, making it more susceptible to rupture during labor. A repeat CS can help avoid the risk of uterine rupture and ensure a safe delivery. The decision to perform a repeat CS is also influenced by the type of previous uterine incision, with low-transverse incisions being associated with a lower risk of complications.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because a trial of labor after CS (TOLAC) is not recommended for women with a history of previous CS, especially if the previous uterine incision was a low-transverse incision.
**Option B:** This option is incorrect because a planned repeat CS is recommended for women with a history of previous CS, not a vaginal delivery.
**Option C:** This option is incorrect because a planned repeat CS is recommended for women with a history of previous CS, not a history of multiple gestations.
**Clinical Pearl / High-Yield Fact**
A previous uterine incision from a previous CS can increase the risk of uterine rupture by 2-5 times, making a planned repeat CS a safer option for women with a history of previous CS.
**Correct Answer: D. Planned repeat CS.