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Old 06-13-2011, 10:19 AM   #1
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Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

1. Anyone else with a Classical, T, or J incision…. What did your provider say about when they wanted to schedule the repeat C-Section?
2. Is/Did your doctor do a routine steroid injection to enhance lung development prior to c-section, if so when is that planned/ when was that done?

Not much info out there on what is standard since classicals are pretty rare nowadays, so I am just trying to see if what my OB said is standard.

For me:
1. My OB said at 37 w 0 days she’d schedule a lung maturity test (it is a battery of tests off of amniotic fluid sample- something like PG – L/S- and some other test). If result is positive, she’ll do the c-section the next day. If it is not mature, then we’d wait until the next week and repeat the process. (I think she said the protocol is to try 36-37 weeks)
2. She said at 32 weeks she’d give me a steroid injection to give the lung development an extra boost.

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Old 06-13-2011, 10:26 AM   #2
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

Hmmmm. I don't have any personal experience with this, but 37 weeks seems awfully early to me based just on the type of incision.

37 weeks really may be the ideal point to reduce risk of rupture / you going into labor (which I believe would increase the risk of rupture). And it is reassuring she wants to do the steroid injection and check lung maturity first.

But if it were me, I would want to see some research / evidence as to why so early. If she has that to share and discuss with you, then great! If not, I would ask her to either 1) find some research on the topic to use for decision making or 2) let you go a little later (maybe 38 weeks). If the reason for 37 weeks is just "they are more comfortable with that" or something like that, I'd definitely want to see some studies / data before agreeing to deliver that early.
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Old 06-13-2011, 10:34 AM   #3
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

I switched OBs when I had my second because I wanted a VBAC, my first appointment he didnt have all of my paperwork or anything so he just had to take my word that I had a regular low horizontal incision.

But we discussed options at that appointment. He said if it turned out I had a vertical incision(my csection was an emergency) that we would have the csection at 39 weeks unless I went into labor earlier. No steriod shots needed unless I went into labor prior to 37 weeks and they would give the shot and keep me on bedrest at the hospital for 48 hours if possible before the csection.

37 weeks seems really really early to me just based on the type of incision.
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Old 06-13-2011, 01:00 PM   #4
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

I have to agree with PP's that I would be fearful of a c/s at 37 wks. EDDs can be off either way, and babies develop so much in those last few weeks...

Did your doc give you any reasons why he/she is wanting to schedule your c/s so early?

ACOG (who I do not love) does not recomend performing c/s prior to 39 wks except in emergent situations.

I'm not familiar with these types of incisions, but I cannot imagine how they could warramt such an early repeat c/s.
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Old 06-13-2011, 02:52 PM   #5
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

Most likely, the reasoning for scheduling a repeat cesarean for 37 weeks is that due to the classical incision, and higher instance of rupture, the OB doesn't want her going into labor - at all.


If I were scheduling a repeat cesarean - even after a classical incision - I would not feel comfortable scheduling at 37 weeks - even after considering the increased risk of uterine rupture after a classical incision VS a low, bikini cut. I would head to the hospital immediately upon labor beginning for a cesarean. If I 'had' to schedule, or wanted to schedule, I'd do it for a minimum of 39 weeks.
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Old 06-13-2011, 10:12 PM   #6
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

I have been doing some searches on the internet. 39 weeks is the accepted time for doing repeat c sections for low transverse. There is lower risk of uterine rupture, so there is less concern if you happen to sponaneously go into labor.

Dr said that even BH contrax could rupture (I think it would be pretty rare), but nonetheless, it would take me 35 mn to get to the hosplital after having a contraction, so they want to avoid any possibility that I will go into labor on my own before the csection.

In my searches, I have seen anywhere from 36-38 wks, although 38 most common. Both my dr and the perinatologist that did my ultrasound said as low as 36 weeks is within the guidelines they give doctors, and it is sort of up to their experience how they want to handle. I happened to have my water break at 38w 4 d with my son, and so I wonder if they don't want to do the most conservative route. It seems I may be able to convince her to allow me to be on bedrest from 37 to 38 weeks. I start working on her


Oh, and specifically, anyone with a classical incision- I am dying to hear what your doctor said for you! I really do appreciate the comments from everyone, but since these incisions seem to be so few and far between (THANK GOODNESS!!), looking for first hand experience.
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Old 06-16-2011, 08:39 PM   #7
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

I don't have a classical incision but have had a crash c-section (five minutes from decision to incision) and a perforation unrelated to c-sections and a second c-section that will be about 21 months from the date of my next section. I also am already contracting at least 6x an hour at 30 weeks.

My perinatologist wants to deliver around 35 or 36 weeks to reduce my chance of rupture. He will do an amniocentesis and schedule the surgery the next day if all goes well.

It's not ideal but my water broke at 34 weeks with my oldest and I was contracting every 1-2 minutes at 35/36 weeks when my second c-section was done.
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Old 06-17-2011, 10:57 AM   #8
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

I have a T incision and my Dr has mentioned the possibility of doing an amnio at 37 weeks and then schedule the c section. I plan to discuss this more at my next appointment though. No mention of a steroid shot
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Old 06-17-2011, 11:37 AM   #9
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

37 weeks.. that is still so early. I would refuse until 39 weeks, and at the absolute earliest and only if truly needed for me or baby's safety, 38 weeks.

Rupture rates are pretty low. It'd be a different story of they were even in double digits, but they aren't. Even classical and T incisions are below 10% rupture rate. I'd try for a VBAC personally, but if I were in your shoes and already made the decision for a csection, I'd insist on waiting until 39 weeks. I've known babies born at 37 weeks that needed to be in the NICU because they were premature.
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Old 06-21-2011, 10:35 PM   #10
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Re: Timing for Repeat CSection for Classical or other Non-Low Transverse Incision

Quote:
Originally Posted by Mystery View Post
I don't have a classical incision but have had a crash c-section (five minutes from decision to incision) and a perforation unrelated to c-sections and a second c-section that will be about 21 months from the date of my next section. I also am already contracting at least 6x an hour at 30 weeks.
No Kidding! I can see the reason to deliver early due to your past experiences. History likely to repeat once the tissue has already been there. Steroid shot in your future, then? (If not already?)


Quote:
Originally Posted by 5littlesweeties View Post
I have a T incision and my Dr has mentioned the possibility of doing an amnio at 37 weeks and then schedule the c section. I plan to discuss this more at my next appointment though. No mention of a steroid shot
Thanks for info! Sounds in line with my dr. I too plan on discussing with Dr to wait until 38. Unfortunately, my options are 37w 1day, 37w 2days, 38w 1day since my dr only does surgeries on Weds and Thurs. I couldn't just push it out a half week, since that is the weekend...
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