TOLAC Flashcards
Contraindications to TOLAC
- history of classical or T-incision CD
- prior transfundal surgery
- prior uterine rupture
- other contraindications to vaginal delivery (placenta accreta)
- non vertex presentation
candidates for TOLAC
- 1 or 2 prior LTCD
- previous low vertical CD (not extending to fundus)
- multiple gestation
- previous CD with unknown scar unless strongly suspect classical CD
true or false - all prostaglandins are contraindicated for IOL with TOLAC
false. misprostol (PGE1) is contraindicated (15% rupture risk).
is ECV okay with prior CD?
yes; okay with prior LTCS
rupture risk:
- background risk
- undocumented scar
- twins
- previous lower segment rupture
- previous upper segment rupture
- classical CD
- induction with PGE1
- PG induction for 2nd trimester
- background risk: 1%
- undocumented scar: 1%
- twins: 1%
- previous lower segment rupture: 6%
- previous upper segment rupture: 32%
- classical CD: 10%
- induction with PGE1: 15%??
- PG induction for 2nd trimester: < 1%
how do you perform IOL for TOLAC?
- transcervical foley
- misoprostol okay with 2nd tri loss
- even with classical/T-incisions, TOLAC is acceptable option with IUFD (with miso)
VBAC success rates?
if prior CD for/not for CDP
60-80% overall. if prior CD for CPD -> 66%; if not for CPD -> 75%
rate of CD in 1996 and 2009?
20.7% and 31.9%
what is the most common sign of uterine rupture?
fetal heart rate abnormality - up to 70% cases. continuous monitoring recommended.
management of pregnancies with contraindication to TOLAC?
delivery by CD between 36 and 37 weeks should be considered; individualized plan should be considered
analgesia choice?
patient can choose- epidural may be used as part of labor.
any difference between 1 or 2 prior CDs?
2 may have slightly increased risk of failure
factors associated with increased risk of rupture?
induced labor over spontaneous, EGA > 40 weeks (minimally), multiple gestations, clinical macrosomia without prior deliveries, higher maternal age, nonwhite ethnicity
