Vaginal Birth After C-Section Flashcards
What are the delivery options in a patient with previous C-section?
- Vaginal birth after C-section (VBAC)
- Planned elective repeat C-section
What % of women worldwide deliver via C-section?
20%
What is becoming increasingly important with a rise in C-sections?
Counselling patients about vaginal birth after C-section
Who is VBAC safe for?
The majority of women who have had 1 prior low segment C-section
What are the current success rates for attempted VBAC?
72-75%
What increases the success rate for VBAC?
Women who have had a previous vaginal delivery
What is the strongest predictor of success in VBAC?
Previous VBAC
What is the success rate of VBAC after previous VBAC?
85-90%
When is a more cautious approach required in VBAC?
- Multiple pregnancy
- Macrosomia
- Maternal age >40 years
What should be done when higher risk cases want VBAC?
Should discuss their care with a senior obstetrician
How does VBAC compare to elective repeat C-section, with respect to hospital stay and recovery?
If VBAC is successful, has a shorter hospital stay and recovery
How does VBAC compare to elective repeat C-section, with respect to risk of uterine rupture?
- With VBAC, risk is 0.5%
- C-section there is almost no risk (<0.02%)
How does VBAC compare to elective repeat C-section, with respect to anal sphincter injury?
- With VBAC, 5% risk of anal sphincter delivery
- C-section, no risk
How does VBAC compare to elective repeat C-section, with respect to maternal death?
- With VBAC, 4 in 100,000 risk of maternal death
- C-section 13 in 100,000
How does VBAC compare to elective repeat C-section, with respect to future deliveries?
- If VBAC is successful, good chance of successful VBACs in the future.
- If C-section, subsequent pregnancies likely to require C-section
How does VBAC compare to elective repeat C-section, with respect to neonatal morbidity?
- In VBAC, 2-3% risk of transient respiratory difficulties for the neonate.
- In C-section, 4-5% risk of neonatal respiratory morbidity
How does VBAC compare to elective repeat C-section, with respect to risk of neonatal hypoxic ischaemic encephalopathy?
- 0.08% in VBAC
- <0.01% in C-section
What is the risk of stillbirth beyond 39 weeks whilst awaiting spontaneous labour in VBAC?
0.1%
What risks increase with each C-section delivery?
- Placental problems, including accrete and praevia
- Adhesion formation
Where should VBAC take place?
In hospital setting, with facilitates for emergency C-section and advanced neonatal resuscitation
What monitoring should be done in VBAC?
Continuous CTG monitoring
Why should you be aware of any additional analgesic requirement during labour with VBAC?
May indicate impending uterine rupture
What should be avoided if possible with VBAC?
Induction
What type of induction has a reduced risk of uterine rupture in VBAC?
Mechanical techniques, e.g. amniotomy (compared to prostaglandins, which has a higher risk)
