Next Birth After Caesarean Section

Question 1

What are the maternal risks and benefits of a vaginal birth after CS (VBAC) over elective CS after CS (ERCD)?

Answer 1

• Risks: uterine rupture, infection more likely
• Benefits: maternal death, hysterectomy, transfusion less likely. Shorter hospital stay expected. Less future risk of placenta accreta

Question 2

Which particular groups of women are more suitable for trial of labour (TOLAC) and VBAC? Which are less suitable?

Answer 2

• Good for TOLAC/VBAC
  
  • Multipara (e.g. previous VB), spontaneous labour, foetal weight < 4000g
• Bad for TOLAC/VBAC
  
  • Induced labour (no PGs if previous CS), no previous vaginal delivery
  • Classical CS/previous rupture - contraindicated

Question 3

What are the clinical features that signify uterine rupture (e.g. in a trial of labour after CS)

Answer 3

• Prolonged foetal bradycardia (unexplained)
• Pain at previous scar site
• Vaginal bleeding
• Loss of presenting part
• Contractions slow
• Signs of shock

Question 4

What are the foetal risks and benefits of TOLAC/VBAC over ERCD

Answer 4

• TOLAC
  
  • Risks - higher neonatal mortality (low absolute risk), HIE, intubation for MAS
  • Benefits - less risk of respiratory problems, birth trauma
  • No difference in: APGARs or NICU admissions