Vaginal birth after cesarean (VBAC) Quiz: Ace Your Exams
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A 34-year-old woman, gravida 4, para 2 at 36 weeks of gestational age, presents to discuss her mode of delivery. Her first delivery was an uncomplicated cesarean birth at 41 weeks for arrest of dilation during labor 5 years ago. This was followed by a spontaneous miscarriage at 10 weeks that was managed with a dilation and curettage 3 years ago. Her third pregnancy was complicated by an acute placental abruption following a motor vehicle accident that resulted in an emergent cesarean birth at 25 weeks of gestational age 23 months ago. No prior surgical records are available. The current pregnancy has been uncomplicated. Past medical history is also notable for a hysteroscopic myomectomy of a small submucosal leiomyoma that was causing heavy menstrual bleeding 7 years ago. Vital signs are within normal limits and body mass index is 26 kg/m2. On abdominal exam, two low transverse skin incisions are noted, and the fundal height is 36 cm. Obstetric ultrasound shows a single viable fetus in the vertex presentation with a normal fetal heart rate, posterior placenta, and adequate amniotic fluid. Which of the following is a contraindication to a trial of labor after cesarean (TOLAC)?
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