Pros and Cons VBAC/ERCS

Question 1

Planned VBAC - Maternal Outcomes

Answer 1

• 72-75% success
• 1 or more previous SVD 85-90% success
• Shorter hospital stay
• 0.5% risk of scar rupture
• Increase likelihood of future vaginal deliveries
• 5% risk of anal sphincter injury - fetal weight highest predictor
• Risk of instrumental delivery 39%
• Risk of maternal death 4/100 000

Question 2

Planned VBAC - Fetal outcomes

Answer 2

• TTN 2-3%
• 10/10 000 risk of stillbirth beyond 39/40 (same as nulliparous)
• 8/10 000 HIE
• 4/10 000 perinatal death

Question 3

ERCS - Maternal outcomes

Answer 3

• Planned
• No risk of uterine rupture
• Longer recovery
• Reduced organ prolapse/urinary incontinence in the short term
• Sterilization (higher regret and risk of failure)
• Increased risk of future sections, PP, P accreta
• Risk of maternal death 13/100 000

Question 4

ERCS - Fetal outcomes

Answer 4

• TTN 4-5% (11% at 37/40, 6.2% at 38/40, 1.5% at 39/40)

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Question 5

Successful vs unsuccessful VBAC

Answer 5

Uterine rupture 2.3 vs 1.2%
Hysterectomy 0.5 vs 0.1%
Transfusion 3.2 vs 1.2%
Endometritis 7.7 vs 1.2%
NB - Hysterectomy is needed in 14-33% of uterine ruptures

Question 6

Factors that influence successful VBAC

Answer 6

Greater Maternal height
Maternal age 8cm or failed instrumental
White ethnicity
Failed IOL less success of VBAC