Manual check of scar after VBACThread
Dec 25, 2010 06:34 PM
I would like to know more about the risks and benefits of manually checking the scar of the previous C-section after a successful VBAC. Exactly what kind of information does this method provide, and could this information be obtained by any other method as well? I haven't found any study or other evidence-based resource on this.
Thank you very much in advance.
Dec 30, 2010 11:55 PM
There is no evidence of which I am aware for any benefits of routinely checking a scar, and, of course, there is potential for harm: pain, infection, and converting a harmless window into a scar rupture.
Here is the relevant excerpt from the manuscript for the forthcoming edition of Optimal Care in Childbirth: The Case for a Physiologic Approach to be published by Classic Day Publishing:
"Manual exploration of the scar after birth produces false positives and false negatives. A study of over 1000 women with prior cesareans reported that fewer scar defects were detected by manual palpation than observed during elective repeat cesareans. In two cases, exploratory surgery was performed after doctors thought they felt a defect, only to find one woman had an intact scar. Another study reporting on a postpartum maternal death from hemorrhage noted that the scar had been palpated after the birth, but the rupture was missed. The first study’s investigators questioned the value of identifying asymptomatic scar windows because they seem to pose little risk in subsequent pregnancies, an observation later supported by an ultrasonography study finding that most women with prior cesareans have scar defects. They argued that manual exploration could increase the risk of infection or convert a small, harmless gap into a problem. To this we add that manual scar palpation is excruciatingly painful if the woman does not have an epidural."
Farmer RM, Kirschbaum T, Potter D, et al. Uterine rupture during trial of labor after previous cesarean section. Am J Obstet Gynecol 1991;165(4 Pt 1):996-1001.
Gemer O, Segal S, Sassoon E. Detection of scar dehiscence at delivery in women with prior cesarean section. Acta Obstet Gynecol Scand 1992;71(7):540-2.
All Times America/New_York
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