Question

A pregnant patient, with a history of classical cesarean section in view of fetal growth retardation in the previous pregnancy, presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management? 

• A. Cesarean section at 37 weeks
• B. Advice USG and visit after 2 weeks
• C. Internal podalic version followed by vaginal delivery
• D. External cephalic version at 36 weeks

Answer 1

The Correct Option is A

In a case where a pregnant patient has a history of classical cesarean section, there are specific considerations to ensure both maternal and fetal safety in subsequent pregnancies. A classical cesarean section involves a vertical incision on the uterus, which is associated with a higher risk of uterine rupture in future pregnancies compared to a lower segment cesarean section (LSCS). Therefore, a trial of labor is not recommended after a classical cesarean, and a planned cesarean delivery is advised. Furthermore, the current presentation involves a breech position at 35 weeks, which adds to the complexity.

The recommended management in this scenario, considering the history of classical cesarean section and current breech presentation, is to schedule a cesarean section. The optimal timing for an elective cesarean section in such cases is around 37 weeks of gestation to minimize neonatal complications while avoiding risks associated with pre-term or post-term delivery. Therefore, the correct next step is:

Cesarean section at 37 weeks.