Vaginal birth after caesarean section Flashcards
What delivery options are available to someone who has previously had a C-section?
Vaginal birth after caesarean section
Planned elective repeat caesarean
What percentage of women worldwide deliver via c-section?
20%
What is the success rate for VBAC?
75%
What are the risks of VBAC?
Uterine ruptire
Anal sphincter injury
Maternal death (4 in 100000)
2-3% risk of transient respiratory difficulties
Risk of hypoxic ischaemic encephalopathy
Risk of stillbirth beyond 39weeks while awaiting spontaneous labour 0.1%
What is uterine rupture?
Full thickness disruption of the uterine muscle and overlying seorsa
What can happen to the foetus as a result of uterine rupture?
Foetal hypoxia
What can happen to the mother as a result of uterine rupture?
Internal haemorrhage
What is the greatest risk factor of uterine rupture
Previous c-section
What are the risk factors of uterine rupture during VBAC
Previous c-section Previous uterine surgery Induction Obstruction of labour Multiple pregnancy Multiparity
Describe the management of uterine rupture
Obstetric emergency
ABCDE management
Delivery in theatre
Describe the management of VBAC delivery
Hospital setting
Continuous TG monitoring
What might additional analgesic requirements indicate?
Impending uterine rupture
What is the recommended delivery method after 39 weeks in someone with previous c-section?
C-section
What are some absolute contraindications to VBAC
Classical caesean scar
Previous uterine rupture
CI for vaginal birth - eg. placenta praevia
What are some relative contraindications to VBAC
Complex uterine scars
>2 prior low segment c-sections
