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Obstetrics > Vaginal Birth after Cesarean Section? > Flashcards

Vaginal Birth after Cesarean Section? Flashcards

1
Q

What is the most recent (2016) national cesarean delivery rate?

A

32%

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2
Q

What is the most recent (2016) primary cesarean delivery rate?

A

22%

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3
Q

What is the most recent (2016) VBAC rate?

A

12.4%

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4
Q

In a patient with an IUFD at < 28 wga and history of prior CS delivery, what cervical ripening agents can you use?

A

Misoprostal, balloon catheter

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5
Q

In a patient with an IUFD at > 28 wga and history of prior CS delivery, what cervical ripening agents can you use?

A

Balloon catheter

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6
Q

What are the contraindications to a TOLAC?

A

any contraindication to a vaginal delivery, previous classical or T incision, previous transfundal intrauterine surgery

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7
Q

True or False: If a patient presents in advanced labor with a contraindication for TOLAC she a dher provider may judge it best to proceed with TOLAC

A

True

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8
Q

What is the risk of uterine rupture with prior LTCS?

A

0.5 - 0.9%

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9
Q

In all women attempting TOLAC, what is the probability of VBAC?

A

60 - 80%

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10
Q

The risk of maternal morbidity ______ as the probability of VBAC ______

A

increases, decreases

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11
Q

What factors increase the probability of success?

A

Prior vaginal delivery, spontaneous labor

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12
Q

What factors decrease the probability of success?

A

prior indication of failure to progress, increased maternal age, non white ethnicity, GA > 40 wga, Obesity, PreEclampsia, short interpregnancy interval, increased neonatal birthweight

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13
Q

Who are good candidates for a VBAC?

A

If probability of VBAC > 60 - 70%

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14
Q

Are women with less than or equal to 2 CS deliveries candidates for TOLAC?

A

Yes

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15
Q

Are women with greater than 2 CS deliveries candidates for TOLAC?

A

No

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16
Q

Are patients with an unknown scar type candidates for TOLAC?

A

Yes, unless strong suspicion of previous classical

17
Q

True or false: Both induction and Augmentation increase the risk of uterine rupture?

A

True

18
Q

Does a macrosomic infant 4000 - 4500g increase the risk of uterine rupture?

A

Yes by 2.3 fold

19
Q

Are twins with a history of prior LTCS candidates for TOLAC?

A

Yes

20
Q

Is external cephalic version contraindicated with a history of prior CS delivery?

A

No

21
Q

If a patient has a history of uterine rupture is it safe for her to TOLAC?

A

No

22
Q

What is recurrence risk of uterine rupture if the previous rupture occurred in the lower uterine segment?

A

6%

23
Q

What is recurrence risk of uterine rupture if the previous rupture occurred in the upper uterus?

A

32%

24
Q

In a patient with history of uterine rupture, when should you consider delivery?

A

36w0d - 37w6d

25
Q

In a patient with an IUFD and previous classical incision is it reasonable to offer TOLAC?

A

Yes

Obstetrics (28 decks)

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