Birth after previous CS GTG

Question 1

What is the rates of CS? Emergency and elective?

Answer 1

overall 25% CS
15% emergency
10% elective

Question 2

Suitability for VBAC

Answer 2

Singleton preg
Cephalic @ 37
Single lower segment CS
previous vaginal birth

Question 3

Contraindications to VBAC

Answer 3

Previous uterine rupture
Prv classical CS
prv uterine surgery where cavity breeched
Placenta praaevia

Question 4

What is the chance of recurrence of uterine rupture

Answer 4

5%

Question 5

Risks of placenta praevia after 1 CS

Answer 5

1%

Question 6

Risks of placenta praevia after 2 CS

Answer 6

1.7%

Question 7

Risks of placenta praevia after 3 CS

Answer 7

3%

Question 8

Risk of placenta accreta with praevia after 1 cs

Answer 8

11-14%

Question 9

Risk of placenta accreta with praevia after 2 cs

Answer 9

23-40%

Question 10

Risk of placenta accreta with praevia after 5 cs

Answer 10

67%

Question 11

Risk of uterine rupture following 1 CS?

Answer 11

0.5% 1/200

Question 12

Risk of uterine rupture following 2 CS?

Answer 12

1.36%

Question 13

Success rates 1CS and 2CS

Answer 13

1CS 75%
2CS 71%

Question 14

Risk of anal sphincter injury in VBAC?

Answer 14

5%

Question 15

Risk instrumental in VBAC?

Answer 15

39%

Question 16

Risk of maternal death VBAC vs CS

Answer 16

VBAC 4/100,000
ERCS 16/100,000

Question 17

What factors increase risk of uterine rupture?

Answer 17

Factors increasing risk rupture
- Short inter-delivery interval <12 months
- Post-date pregnancy
- Mat age >40
- Obesity
- Low prelabour bishop score
- Macrosomia
- Decreased USS lower segment thickness

Question 18

How often hysterectomy required if uterine rupture?

Answer 18

14-33%

Question 19

Risk of stillbirth whilst awaiting labour with VBAC

Answer 19

10 per 10000

Question 20

Risk of HIE in VBAC

Answer 20

8 per 10,000 (o.o8%)

Question 21

Risk perinatal death in VBAC?

Answer 21

4 per 10,000 (0.04%)

Question 22

Risk of perinatal death or HIE in ERCS from 39 weeks

Answer 22

<0.01%

Question 23

VBAC success rates if previous vaginal delivery?

Answer 23

85-90%

Question 24

What % of women with uterine rupture will have
- abnormal CTG?
- Abdo pain

Answer 24

66-76% CTG
50% abdo pain

Question 25

What % uterine rupture occurs in labour? Peak incidence in CM

Answer 25

90% occur in labour
4-5cm

Question 26

Clinical features of scar rupture in labour?

Answer 26

• Abnormal CTG
• Severe abdo pain, especially if persisting between contractions
• Acute onset scar tenderness
• Abnormal vaginal bleeding
• Haematuria
• Cessation of previously efficient uterine activity
• Maternal tachycardia, hypotension, shock
• Change in abdominal contour and inability to pick up FH
• 48% asymptomatic

Question 27

IOL increases risk of uterine rupture by how much?

Answer 27

2-3 times, higher doses → higher risk

1.5% higher risk EMCS

Question 28

If baby >4kg and P0 risk of rupture?

Answer 28

3.6%

<50% success