VBAC

Question 1

Success rates of VBAC

Answer 1

Overall- 72-75%
Prev VBAC- 85-90%
Prev CS for fetal malpresentation- 85%
Prev CS for fetal distress- 73%
Prev CS for labour dystocia- 65% (better if >8cm)

Question 2

Contraindications

Answer 2

Prev uterine rupture
Classical CS
Major placenta praevia
Think- Women with prev uterine surgery

2 prev CS is NOT a contraindication- explain the risks to pt.

Question 3

Risk factors for uterine rupture?

Answer 3

Risk 1:200
Short delivery interval <12months
Postdates
Mat age >40
Obesity
Macrosomia
Thin lower seg on scan

Question 4

Signs of scar rupture

Answer 4

Abnormal CTG
Severe pain- esp scar pain
Vaginal bleeding
Heamaturia
Cessation of uterine activity
Maternal - tachy, faint
Unable to pick up FH

Question 5

VBAC vs CS

Answer 5

5% OASI risk
39% instrumental risk
Lower bleeding and hysterectomy risk
Baby:
Resp morbidity 2-3% (less than CS 4-5%)
HIE 8 per 10 000 (CS 1/10 000)

Question 6

Predictors of VBAC

Answer 6

Prev VBAC (best)
Mat age <40
BMI<30
Greater mat height
Gestation <40
Baby <4kg
Spont labour

Question 7

IOL

Answer 7

2-3 fold inc risk of rupture
1.5 fold inc risk of CS
Better to use mechnical methods