Columbus: Vaginal birth after cesarean section Flashcards
What are reasons for increased rate of cesarean section?
Delayed childbearing More nulliparous births Electronic fetal heart rate monitoring Legal climate Section for breech Increase in the diagnosis of dystocia Acceptance of patient choice
What are the most common indications for cesarean section in order?
Repeat 35% Dystocia 28% Other 17% Breach 10% Fetal distress 10%
What are contraindications to VBAC?
Prior classical or T-shaped incision
Extensive transfundal uterine surgery
Previous uterine rupture
Medical obstetrical contraindication to vaginal birth
What are some factors that increase the risk of uterine rupture?
What factors decrease the risk of uterine rupture?
Single layer closure, birth weight greater than 3500 g, maternal fever with previous C-section, maternal age greater than 30 years, labor induced without prostaglandin
Prior vaginal birth
What is the rate of uterine rupture with trial of labor?
With repeat C-section?
- 5-0.7% with trial of labor
0. 03% with repeat C-section
How can perinatal mortality be decreased in the presence of an abnormal heart rate preceding a prolonged fetal heart rate deceleration?
Delivery within 10 minutes
What are signs of uterine rupture?
Fetal bradycardia, late or variable decelerations, vaginal bleeding, lower abdominal pain, lack of uterine activity, uterine hyperstimulation, loss of fetal station
What is the absolute risk of fetal hypoxic ischemic encephalopathy with trial of labor after cesarean?
0.05% or 1/2000
What is the perinatal mortality rate for TOLAC?
What is the maternal mortality rate?
About 0.1% or 4–13/10,000
0.004% or 1/25,000
What is the prevalence of placenta accreta?
What is the rate of placenta accreta with prior CD?
5%
One prior is 24%
Two prior is 47%
Four or more prior is 67%
What is the rate of stress urinary incontinence in nulliparous women?
Following vaginal delivery?
Following cesarean section?
11%
21%
16%
What is the incidence of placenta previa?
What is the relative risk with increasing number of CDs?
0.5% or 1/200 deliveries
One prior is 4.5 RR or 2%
Two prior is 7.4 RR or 3.7%
Three prior is 6 RR or 3%
Four or more prior is 44.9 RR or 22%
What is the rate of pelvic organ prolapse following vaginal delivery?
1%
According to ACOG who are good candidates for TOLAC?
Most women with one prior CD with a low transverse incision should be offered TOLAC if their VBAC probability is greater than 60%.
