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Practice bulletins > #205 Vaginal Birth After Cesarean Delivery > Flashcards

#205 Vaginal Birth After Cesarean Delivery Flashcards

1
Q

What was the US c section rate in 1970?

A

5%

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2
Q

What was the US c section rate in 2016?

A

31.9%

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3
Q

What are the benefits of VBAC compared to scheduled repeat cesarean section?

A

Avoid major abdominal surgery, lower rates of hemorrhage, thromboembolism, and infection, shorter recovery period. Decrease risk related to multiple CS (hyst, bowel bladder injury, abnormal placentation, infection)

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4
Q

When does most maternal morbidity occur related to TOLAC?

A

When repeat cesarean section becomes necessary

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5
Q

Put in order from least to most maternal morbidity/mortality risk: repeat cesarean section, VBAC, repeat CS after TOLAC

A

VBAC, repeat CS, repeat CS after TOLAC

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6
Q

What is the risk of uterine rupture during TOLAC with one prior lower transverse uterine incision?

A

0.5-0.9%

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7
Q

What is the vaginal delivery rate in a general population of TOLACs?

A

60-80%

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8
Q

True or false: women with prior cesarean section are more likely to have successful VBAC if they are induced rather than spontaneous labor?

A

False, less likely to achieve VBAC than spontaneous labor

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9
Q

Does maternal age affect success rate of VBAC?

A

Yes, decreasing success rate with increasing age

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10
Q

Does gestation age at time of delivery affect rate of VBAC success?

A

Yes, advanced GA (>40 wks), associated with lower success

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11
Q

Does short interval pregnancy affect chances of successful VBAC?

A

Decreases success rate

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12
Q

Does preeclampsia affect the chances of successful VBAC?

A

Yes, decreases chances

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13
Q

How does BMI affect chances of successful VBAC

A

Lower chance with higher BMI

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14
Q

How does a prior vaginal delivery affect success rate of VBAC?

A

Increases it

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15
Q

Do VBAC prediction models (success calculators) improve patient outcomes?

A

Has not been shown to

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16
Q

Women with < what % chance of successful VBAC are more likely to experience morbidity than women with elective repeat cesarean delivery?

A

<60%

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17
Q

Women with what prior uterine scar(s) are candidates for VBAC?

A

Low transverse (up to 2), low vertical, unknown scar (unless high clinical suspicion for prior classical incision)

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18
Q

What is the risk of uterine rupture for TOLAC with two prior LTCS?

A

0.7-1.8%

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19
Q

Is suspected macrosomia a contraindication to TOLAC?

A

No

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20
Q

Is gestational age >40wks a contraindication to TOLAC?

A

No, but success rate of VBAC is lower after 40wks

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21
Q

Does twin gestation affect the risk fo uterine rupture?

A

No

22
Q

Does twin gestation affect the success rate of VBAC?

A

No

23
Q

Is a twin gestation a contraindication to TOLAC?

A

No, as long as otherwise candidate for vaginal delivery

24
Q

How does BMI affect the success rate of a successful VBAC?

A

Increased BMI leads to decreased success of VBAC

25
Q

Is high BMI a contraindication to TOLAC?

A

No, but decrease chance of success

26
Q

What is the risk of uterine rupture with prostaglandin induced labor after prior cesarean section?

A
  1. 4-2.24%

0. 4-0.5% for spontaneous

27
Q

What is the risk of uterine rupture with oxytocin use in patient with prior cesarean section?

A

1.1%

28
Q

Are women more likely to achieve VBAC with spontaneous or induced labor?

A

Spontaneous labor

29
Q

Is mechanical dilation an acceptable option for women who desire TOLAC with an unfavorable cervix?

A

Yes. Although studies vary on whether it increases the risk of uterine rupture, but no significant date exists

30
Q

What medication is prostaglandin E1?

A

Misoprostol

31
Q

Can you use prostaglandin E1 to induce or perform cervical ripening in a patient with a prior C-section? Prior major uterine surgery?

A

No x 2. Increase risk of uterine rupture

32
Q

Can you use prostaglandin E2 to perform cervical ripening or induce labor in a woman with a prior cesarean section?

A

data are limited and so it is difficult to make recommendations

33
Q

Can you perform an external cephalic version and a woman with a prior low transverse C-section?

A

Yes. As long as otherwise a candidate for external cephalic version and vaginal delivery.

34
Q

Does a prior cesarean section affect the success rate of external cephalic version?

A

No

35
Q

Does an epidural mask signs or symptoms of uterine rupture during labor in a woman with a prior cesarean section?

A

No. Most common sign is fetal heart rate abnormalities

36
Q

Do you labor curves in a woman with a prior cesarean section differ from women without a prior cesarean section?

A

No. They seem to follow the same labor curves.

37
Q

Is it recommended to use fetal scalp electrode or intrauterine pressure catheter during labor for women with a prior cesarean section?

A

There are no data to suggest that internal modeling is superior to external monitoring

38
Q

Does an intrauterine pressure catheter assist in the diagnosis of uterine rupture?

A

There is evidence that it does not help

39
Q

What is the most common sign indicative of uterine rupture during labor? How often does this occur?

A

Fetal heart rate abnormalities in up to 70% of cases

40
Q

Can you perform intermittent fetal heart monitoring during labor for a TOLAC?

A

Continuous monitoring is recommended

41
Q

What are the possible signs and symptoms of uterine rupture during labor?

A

Fetal bradycardia, increased uterine contractions, vaginal bleeding, loss of fetal station, or sudden intense uterine pain

42
Q

Should you repair an asymptomatic uterine scar dehiscence after VBAC?

A

Has not been shown to improve outcomes

43
Q

If a patient has uterine rupture during TOLAC, And it is contained to the lower uterine segment, what is the risk of future uterine rupture or dehiscence during labor?

A

6%

if includes upper portion of uterus, as high as 32%, most recent study says 15%

44
Q

If a patient has a uterine rupture during TOLAC, and rupture includes upper portion of the uterus, what is the risk of uterine scar dehiscence or rupture during future labor?

A

Up to 32%, but most Recent report states 15%

45
Q

By what method and at what gestational age should you deliver a woman who has had a prior uterine rupture during labor?

A

Deliver via cesarean section between 36 weeks zero days and 37 weeks zero days, But can be individualized based on clinical situation

46
Q

Can you use prostaglandins to induce labor for a woman in the second trimester with a history of a prior C-section? What is the risk of uterine rupture in the setting?

A

You can use prostaglandins in the second trimester. The risk of uterine rupture is less than 1%

47
Q

After what gestational age should you not use misoprostol for labor induction for a woman with a prior cesarean section?

A

28 weeks

48
Q

If a patient has a diagnosed IUFD At 30 weeks with an unfavorable cervix and history of prior cesarean section, what cervical ripening can you do?

A

Mechanical

49
Q

What is a requirement of a facility offering TOLAC?

A

Ability to perform emergent C Section

50
Q

Can patients undergoing TOLAC Have a homebirth?

A

It is contraindicated

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