What is a contraindication for Trial of Labor after Cesarean (TOLAC)?

A previous uterine rupture is a well-established contraindication for Trial of Labor after Cesarean (TOLAC) because it significantly increases the risk of uterine rupture during subsequent labor. When a uterine rupture has occurred in past pregnancies, the integrity of the uterine wall is compromised, posing a serious threat to both the mother and the fetus if labor is attempted.

In cases of previous uterine rupture, the risk of recurrence during a subsequent labor is high, leading to potentially catastrophic outcomes such as fetal distress or maternal hemorrhage. Therefore, such a history necessitates careful consideration of the safety of attempting a vaginal delivery, and in this context, a repeat cesarean delivery is typically recommended to minimize risk.

Other considerations, such as general anesthesia, multiple gestations, or post-term pregnancy, do not inherently contraindicate TOLAC. While they may add complexity to the situation, they do not pose the same critical increase in risk regarding uterine integrity as a previous uterine rupture does.