Which of the following is NOT a candidate for Trial of Labor After Cesarean (TOLAC)?

In the context of considering candidates for a Trial of Labor After Cesarean (TOLAC), the presence of a classical uterine scar is a significant factor that disqualifies a woman from safely attempting a vaginal delivery after a cesarean section. A classical scar, which is a vertical incision made on the upper segment of the uterus, is associated with a higher risk of uterine rupture during labor compared to these other scenarios.

This increased risk is tied to the nature of the incision itself; classical incisions involve a broader and less well-healed area of myometrium. The contraction of the uterus during labor can place excessive stress on this scar, leading to potential complications for both the mother and the fetus. As a result, women with a classical scar are strongly advised against attempting TOLAC due to the heightened danger of uterine rupture.

On the other hand, having one or two low transverse cesarean scars generally presents a lower risk and can be candidates for TOLAC, provided other clinical factors are favorable. Additionally, a clinically adequate pelvis demonstrates a sufficient maternal pelvic size to accommodate a vaginal delivery, making it an important consideration in favoring TOLAC.