Delivery in the scarred uterus. Apropos of 606 cases in 62,193 deliveries

Scarred uterus represent 1 p. cent of the deliveries in our department (n = 606). Delivery is performed vaginally in 61 p. cent of the cases and by caesarean section in 39 p. cent of the cases. During two 4-year periods (1981-1984 and 1985-1988), the rate of repeated caesarean sections increases from 36 to 41 p. cent with decrease of the number of uterine ruptures which however, persists (almost 5 p. cent of scarred uteruses). The type of scarring is the major risk factor with: segmental scarring (1.5 p. cent of ruptures), gynecological (5 p. cent), segmento-corporeal (26 p. cent) and corporeal (33 p. cent). Strict obstetrical monitoring permits to control this risk (25 p. cent of ruptures occur at home). It is the uterine rupture that determines the maternal risk (3 death scarred uteruses represent almost 40 p. cent of uterine ruptures 11) and result in 3 p. cent of the maternal mortality in the department. The perinatal mortality is 63.6 for 1,000. A dynamic test of the uterus requires an obstetrical decision taking into consideration the scar, essentially segmental transverse, the head delivery with favorable cephalo-pelvic comparison and a well-trained team. This choice is dictated by the maternal risk of caesarean section, 2 for 1,000 in Europe (14) and for 1,000 in the department and a persistent high mortality in children (97 for 1,000 in Gabon).