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OBSTETRICS > PRIOR CS DELIVERY > Flashcards

PRIOR CS DELIVERY Flashcards

1
Q

By the beginning of the 20th century, what had become a relatively safe procedure?

A

“Cesarean delivery.”

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2
Q

What was the danger associated with cesarean delivery in the early 20th century?

A

“Rupture of the uterine scar with subsequent labor.”

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3
Q

Who coined the remark ‘Once a cesarean, always a cesarean’?

A

“Cragin (1916).”

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4
Q

Which practitioner described a 30-percent postcesarean vaginal delivery rate?

A

“Eastman (1950).”

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5
Q

What was the uterine rupture rate reported by Eastman in his study?

A

“2 percent.”

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6
Q

What was the associated maternal mortality rate in Eastman’s study?

A

“10 percent.”

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7
Q

In the 1960s, what was the overall cesarean delivery rate?

A

“Approximately 5 percent.”

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8
Q

Which NIH Consensus Development Conference questioned vaginal birth after cesarean?

A

“1981 NIH Consensus Conference on Vaginal Birth After Cesarean.”

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9
Q

What was the peak percentage of VBAC in the United States?

A

“28.3 percent in 1996.”

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10
Q

What term refers to a trial of labor after a cesarean?

A

“TOLAC.”

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11
Q

What major complication dampened enthusiasm for VBAC?

A

“Uterine rupture-related maternal and perinatal morbidity and mortality.”

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12
Q

Which professional organization issued recommendations to ensure physicians were ‘immediately available’ during TOLAC?

A

“American College of Obstetricians and Gynecologists (ACOG).”

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13
Q

Between 1990 and 2009, when did the proportion of women attempting TOLAC peak?

A

“1995.”

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14
Q

By 2006, what was the nadir percentage of women attempting TOLAC?

A

“16 percent.”

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15
Q

What term refers to elective repeat cesarean delivery?

A

“ERCD.”

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16
Q

What are the two basic choices for women with prior cesarean delivery?

A

“Trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery (ERCD).”

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17
Q

What factors influence the success of TOLAC?

A

“Low-risk factors include transverse incision

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18
Q

Which incision type is associated with a higher risk in TOLAC?

A

“Classical or T incision.”

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19
Q

What is the absolute risk of uterine rupture during TOLAC?

A

“0.47 percent.”

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20
Q

How does the uterine rupture risk for TOLAC compare to ERCD?

A

“TOLAC has a significantly higher risk of uterine rupture compared to ERCD.”

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21
Q

How do maternal morbidity rates compare between TOLAC and ERCD?

A

“TOLAC carries a higher risk of morbidity

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22
Q

What is the perinatal risk of mortality for women attempting TOLAC compared to ERCD?

A

“TOLAC has higher perinatal mortality rates compared to ERCD.”

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23
Q

What major complication is significantly greater with a failed TOLAC?

A

“Uterine rupture.”

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24
Q

What is the incidence of hypoxic ischemic encephalopathy (HIE) in TOLAC compared to ERCD?

A

“HIE is more common in TOLAC than in ERCD.”

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25
Q

How does the rate of neonatal bag and mask ventilation compare between TOLAC and ERCD?

A

“Higher in TOLAC (5.4 percent) compared to ERCD (2.5 percent).”

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26
Q

What is the main challenge when counseling women about the success of VBAC/OLAC?

A

There is limited high-quality data guiding the selection of suitable VBAC candidates, and predictive tools have not been validated for adverse maternal outcomes like uterine rupture.

27
Q

What is the recommendation for women with a prior low transverse hysterotomy regarding VBAC?

A

Most women with one prior low transverse hysterotomy are considered candidates for VBAC and should be counseled about both VBAC and ERCD options.

28
Q

Is home birth recommended for women attempting VBAC?

A

Home birth is contraindicated for women attempting VBAC.

29
Q

How does the type of prior uterine incision affect the recommendation for VBAC?

A

The type and number of prior cesarean deliveries are key factors. Low transverse incisions have the lowest risk of symptomatic scar separation, while vertical or classical incisions increase rupture risk.

30
Q

What is the risk of uterine rupture in women with a prior classical uterine incision?

A

Women with a classical uterine incision have the highest risk of uterine rupture, potentially even before labor onset.

31
Q

What is the risk of uterine rupture in women with a prior vertical incision extending into the fundus?

A

Women with a prior vertical incision extending into the fundus have a significantly increased risk of uterine rupture.

32
Q

What should be the recommended delivery time for women with a prior classical cesarean incision?

A

Delivery is recommended between 36 0/7 and 37 0/7 weeks for women with a prior classical cesarean incision.

33
Q

How does the number of prior cesarean deliveries affect the risk of uterine rupture?

A

The risk of uterine rupture doubles or triples with two prior cesarean deliveries compared to one, although some studies do not confirm this.

34
Q

How can sonographic evaluation of a prior cesarean incision be used in VBAC planning?

A

Sonographic evaluation of a prior cesarean incision can predict rupture risk. Thinner residual myometrial thickness is associated with a higher risk of rupture.

35
Q

What is the risk of uterine rupture for women with a prior uterine rupture?

A

Women with a prior uterine rupture have an increased risk of recurrence, with a 6% risk for lower-segment rupture and 9-32% for upper-segment rupture.

36
Q

What is the recommended timing between deliveries to reduce uterine rupture risk?

A

Interdelivery intervals of ≤18 months are associated with a threefold higher risk of uterine rupture. An interval >18 months reduces this risk.

37
Q

How does prior vaginal delivery affect the success of VBAC?

A

Prior vaginal delivery improves the success of VBAC and reduces the risk of uterine rupture and other morbidities.

38
Q

What is the VBAC success rate for women with a prior cesarean delivery due to breech presentation?

A

The VBAC success rate is nearly 90% for women with a prior cesarean delivery due to breech presentation.

39
Q

How does fetal size affect VBAC success and the risk of uterine rupture?

A

Increasing fetal size is inversely related to VBAC rates. The risk of uterine rupture increases with fetal weight >4000g but is not significantly linked.

40
Q

Can a woman with a previous cesarean delivery attempt a vaginal delivery with a breech fetus?

A

Although data is limited, external cephalic version and vaginal breech delivery are not recommended for women with a prior cesarean incision.

41
Q

Does twin pregnancy increase the risk of uterine rupture for VBAC?

A

No, twin pregnancy does not increase the risk of uterine rupture. VBAC success rates are comparable to singleton pregnancies.

42
Q

How does maternal obesity impact VBAC success?

A

Obesity decreases the likelihood of VBAC success, with lower success rates as BMI increases.

43
Q

What is the recommended approach for labor induction in women attempting VBAC?

A

Labor induction is generally avoided in women with an unknown prior incision type or an unfavorable cervix. Misoprostol (PGE1) is contraindicated.

44
Q

At what gestational age should ERCD be scheduled if not medically indicated?

A

ERCD should be delayed until at least 39 completed weeks of gestation to reduce neonatal morbidity.

45
Q

How can accurate pregnancy dating affect ERCD scheduling?

A

Accurate pregnancy dating using last menstrual period and sonography is essential to ensure the fetus is mature before ERCD.

46
Q

What is the role of facilities in VBAC and ERCD management?

A

Labor in VBAC patients should be undertaken in facilities capable of providing emergency cesarean delivery if needed.

47
Q

Why is labor induction associated with higher VBAC failure rates?

A

Labor induction is associated with higher VBAC failure rates due to the risk of uterine rupture and other complications.

48
Q

What is the most common sign of uterine rupture during labor in women attempting VBAC?

A

“Nonreassuring fetal heart rate pattern with variable decelerations that may evolve into late decelerations and bradycardia.”

49
Q

How does hemoperitoneum from uterine rupture present?

A

“It may cause diaphragmatic irritation with pain referred to the chest

50
Q

What is the typical fetal outcome if the fetus is expelled into the peritoneal cavity after uterine rupture?

A

“Chances of intact fetal survival are poor

51
Q

What is the impact of delivery time on neonatal outcomes in cases of uterine rupture?

A

“Delivery within 18 minutes of the decision to deliver improves neonatal outcomes

52
Q

How does the risk of maternal mortality from uterine rupture differ globally?

A

“In Canada

53
Q

What are the key clinical signs that indicate uterine rupture during labor?

A

“Fetal distress

54
Q

What may be a comorbid injury following uterine rupture?

A

“Bladder injury

55
Q

What is the incidence of neonatal encephalopathy following uterine rupture during TOLAC?

A

“Neonatal encephalopathy occurs in 6% of cases of uterine rupture during TOLAC.”

56
Q

How does the number of prior cesarean deliveries affect the risk of placenta accreta spectrum (PAS)?

A

“The risk of PAS increases with each prior cesarean delivery

57
Q

What complication is most common with increasing numbers of cesarean deliveries?

A

“Placenta accreta spectrum (PAS) and associated complications

58
Q

What are the risks of repeat cesarean delivery for women with multiple prior cesareans?

A

“Increased risk of complications like wound infection

59
Q

How does the risk of complications change with five or more cesarean deliveries?

A

“There is an 18-fold increase in the risk of major hemorrhage and a 17-fold increase in visceral damage.”

60
Q

How do outcomes differ between TOLAC and ERCD?

A

“TOLAC is associated with higher maternal and neonatal morbidity and mortality compared to ERCD

61
Q

What should be included in counseling for women considering TOLAC?

A

“Discussion of the prior uterine incision

62
Q

Which medical conditions should be considered when planning TOLAC?

A

“Conditions such as multiple prior cesareans

63
Q

Is induction safe in women planning TOLAC?

A

“Induction with oxytocin or Foley catheter is generally safe

64
Q

How can the risk of uterine rupture be mitigated during TOLAC?

A

“Careful monitoring with continuous electronic fetal monitoring (EFM)

OBSTETRICS (13 decks)

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