Classical Uterine Incision: Is Third Pregnancy Dangerous?

I am 20 weeks pregnant with my second baby and diagnosed with complete placenta previa. I had a classical cesarean section with my first child, and my doctor suggests I consider a tubal ligation. How risky would a third pregnancy be?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Classical incisions are rare today. It is a vertical incision into the uterus itself. The skin incision is often vertical, however, but this has no bearing on the type of incision used in the uterus.

Because a classical incision increases risk of rupture with a subsequent pregnancy and labor, a repeat cesarean is usually done.

Scar tissue within the uterus can interfere with placentation (where the placenta attaches to the uterus), increasing risk for placenta previa in subsequent pregnancies. Therefore, a third pregnancy would be at increased risk of a repeat previa. Both this one and the next would need to be delivered by cesarean.

If this pregnancy is accomplished without complications, such as preterm labor and or bleeding resulting from the previa, the risks of problems with a future pregnancy would probably not be as great.

However, this pregnancy is at significant risk for preterm labor and bleeding, so the next one would be as well. It is still possible for the placenta to move up out of the way, but because it has been classified as a complete previa, this may persist as some type of previa. I'm sorry that there are no specific risk percentages to give you, because many variables exist.

A tubal ligation is a very personal decision, and I would not be in a hurry if this is at all undesirable for you and your partner. If possible, I would consult a perinatologist, an obstetrician who specializes in high-risk pregnancies. She could explain current risks and those involved in future pregnancies.

I wish you the best and will be thinking about you in the next few months.

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