Prior classical cesarean delivery-counseling and management

June 1, 2012
Suneet P. Chauhan, MD

Dr. Chauhan is Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston.

A look at what needs to be considered when working with a woman with prior classical cesarean delivery.

Neonatal complications also are significantly more common with classical than with low transverse cesarean deliveries (Table 3). In 1 study, regression analysis indicated that of all the factors that contributed to the risk of neonatal death, gestational age had the greatest impact (odds ratio [OR], 95.8 for gestational age of 28 to 31 weeks; 95% confidence interval [CI], 28.2–325.1), while classical cesarean had the least impact (OR, 1.9; 95% CI, 1.0–3.4).3

Compared with low transverse cesarean deliveries, the perioperative maternal complication rate is significantly higher with classical cesarean. The increased neonatal morbidity and mortality attendant to classical cesarean deliveries predominantly reflect the lower gestational age at delivery, although the type of uterine incision does contribute a small proportion of the risk.