The WILDCARD: LUS Window on Prenatal Sono, TOLAC?

About this episode

This episode discusses the implications of ultrasound measurement of the lower uterine segment in the context of TOLAC and ACOG guidelines.

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assessment. The guideline focuses on clinical factors such as type of prior uterine incision, number of prior cesarean deliveries, and other obstetric history to determine TOLAC candidacy, and emphasizes that most women with one previous low-transverse cesarean delivery should be counseled about and offered TOLAC. But what if you find a likely uterine window at the LUS? Does that mandate a repeat C-section? This topic comes from Serena, one of our podcast family members. Listen in for details. 1. Dr. Chapa’s Clinical Pearls, Dec 31., 2023: LUST FOR TOLAC; and follow up episode Jan 15, 2024 2. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins—Obstetrics Obstetrics and Gynecology. 2019;133(2):e110-e127. doi:10.1097/AOG.0000000000003078. 3…

People in this episode

Host: Hector Chapa

Topics covered

• prenatal ultrasound
• trial of labor after cesarean
• lower uterine segment
• TOLAC
• clinical guidelines

Keywords

• TOLAC
• lower uterine segment
• ultrasound
• cesarean delivery
• ACOG guidelines
• clinical factors
• vaginal birth

Mentioned in this episode

Organizations: American College of Obstetricians and Gynecologists

Books & works: ACOG Practice Bulletin No. 205, American Journal of Obstetrics and Gynecology

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