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A - MSRA Obstetrics [16] > [56] Vaginal Birth After C-Section > Flashcards

[56] Vaginal Birth After C-Section Flashcards

1
Q

What are the delivery options in a patient with previous C-section?

A
  • Vaginal birth after C-section (VBAC)

- Planned elective repeat C-section

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2
Q

What % of women worldwide deliver via C-section?

A

20%

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3
Q

What is becoming increasingly important with a rise in C-sections?

A

Counselling patients about vaginal birth after C-section

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4
Q

Who is VBAC safe for?

A

The majority of women who have had 1 prior low segment C-section

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5
Q

What are the current success rates for attempted VBAC?

A

72-75%

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6
Q

What increases the success rate for VBAC?

A

Women who have had a previous vaginal delivery

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7
Q

What is the strongest predictor of success in VBAC?

A

Previous VBAC

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8
Q

What is the success rate of VBAC after previous VBAC?

A

85-90%

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9
Q

When is a more cautious approach required in VBAC?

A
  • Multiple pregnancy
  • Macrosomia
  • Maternal age >40 years
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10
Q

What should be done when higher risk cases want VBAC?

A

Should discuss their care with a senior obstetrician

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11
Q

How does VBAC compare to elective repeat C-section, with respect to hospital stay and recovery?

A

If VBAC is successful, has a shorter hospital stay and recovery

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12
Q

How does VBAC compare to elective repeat C-section, with respect to risk of uterine rupture?

A
  • With VBAC, risk is 0.5%

- C-section there is almost no risk (<0.02%)

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13
Q

How does VBAC compare to elective repeat C-section, with respect to anal sphincter injury?

A
  • With VBAC, 5% risk of anal sphincter delivery

- C-section, no risk

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14
Q

How does VBAC compare to elective repeat C-section, with respect to maternal death?

A
  • With VBAC, 4 in 100,000 risk of maternal death

- C-section 13 in 100,000

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15
Q

How does VBAC compare to elective repeat C-section, with respect to future deliveries?

A
  • If VBAC is successful, good chance of successful VBACs in the future.
  • If C-section, subsequent pregnancies likely to require C-section
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16
Q

How does VBAC compare to elective repeat C-section, with respect to neonatal morbidity?

A
  • In VBAC, 2-3% risk of transient respiratory difficulties for the neonate.
  • In C-section, 4-5% risk of neonatal respiratory morbidity
17
Q

How does VBAC compare to elective repeat C-section, with respect to risk of neonatal hypoxic ischaemic encephalopathy?

A
  • 0.08% in VBAC

- <0.01% in C-section

18
Q

What is the risk of stillbirth beyond 39 weeks whilst awaiting spontaneous labour in VBAC?

A

0.1%

19
Q

What risks increase with each C-section delivery?

A
  • Placental problems, including accrete and praevia

- Adhesion formation

20
Q

Where should VBAC take place?

A

In hospital setting, with facilitates for emergency C-section and advanced neonatal resuscitation

21
Q

What monitoring should be done in VBAC?

A

Continuous CTG monitoring

22
Q

Why should you be aware of any additional analgesic requirement during labour with VBAC?

A

May indicate impending uterine rupture

23
Q

What should be avoided if possible with VBAC?

A

Induction

24
Q

What type of induction has a reduced risk of uterine rupture in VBAC?

A

Mechanical techniques, e.g. amniotomy (compared to prostaglandins, which has a higher risk)

25
Q

Why should you be cautious of augmentation in VBAC?

A

Increase risk of uterine scar rupture

26
Q

What do any decisions about augmentation and induction in VBAC require?

A

Input from senior obstetrician

27
Q

What is the recommended delivery method after C-section after 39 weeks?

A

Elective repeat C-section

28
Q

By how much is the risk of rupture increased in induced/augmented labour vs spontaneous VBAC labour?

A

2-3x

29
Q

By how much is the risk of need for emergency C-section increased in induced/augmented labour vs spontaneous VBAC labour?

A

1.5x

30
Q

What can the contraindications for VBAC be divided into?

A
  • Absolute

- Relative

31
Q

What is meant by absolute contraindication to VBAC?

A

Under no circumstances should VBAC be considered

32
Q

What is meant by relative contraindication to VBAC?

A

Decisions should be made on case-by-case basis by a senior obstetrician

33
Q

What are the absolute contraindications to VBAC?

A
  • Classical C-section scar
  • Previous uterine rupture
  • Any other contraindications for vaginal birth that apply to the clinical scenario, e.g. placenta praevia
34
Q

What are the relative contraindications to VBAC?

A
  • Complex uterine scars

- >2 prior lower segment C-sections

A - MSRA Obstetrics [16] (61 decks)

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