VBAC Flashcards
Who is suitable for a planned VBAC?
Majority of women with:
- singleton pregnancy
- cephalic pregnancy
- 37+ weeks
- single previous LUSCS
- +/- history of vag birth
What are the contraindications to VBAC?
- previous uterine rupture
- classical caesarean
- other absolute contraindications to vaginal birth irrespective of scar (i.e. praevia)
Can women with 2+ previous caesars be offered VBAC?
- 2+ prior LUSCS may be offered VBAC after counselling by senior obstetrician
- counsel re risk of rupture and maternal morbiditiy
- individual likelihood of successful VBAC (e.g. previous vaginal delivery)
- conducted in appropriate centre
What is the risk of uterine rupture with a planned VBAC?
1 in 200 (0.5%)
What should women be advised regarding risks in VBAC?
- Successful VBAC has fewest complications
- Absolute birth related death comparable for nulliparous women in labour
- Emerg LUSCS after VBAC trial has most
VBAC success rate?
72 - 75%
What determines individual likelihood of successful VBAC?
-Previous vaginal delivery; VBAC success = 85-90%
Counselling re induction or augmentation of labour with VBAC?
-2-3x risk rupture
-1.5x risk caesarean
cf spontaneous VBAC labour
Where should VBAC be conducted?
- staffed and equipped delivery facility
- continuous intrapartum care and monitoring
- resources for urgent LUSCS
- advanced neonatal resuscitation
- continous electronic foetal monitoring
Can women have epidural in VBAC?
Yes, not a contraindication
Which factors favour successful VBAC?
- Previous safe vaginal birth
- Previous successful VBAC
- Spontaneous onset of labour
- Uncomplicated pregnancy without other risk factors
Which factors reduce likelihood of successful VBAC?
- Previous LUSCS for dystocia
- Induction of labour
- Coexisting foetal, maternal or placental conditions
- Maternal BMI 30+
- Foetal macrosomia 4kg+
- Advanced maternal age
- Short stature
- 2+ previous LUSCS
- RFx for scar rupture
What are the benefits of successful VBAC?
- Less maternal morbidity
- Avoid major surgery
- Earlier mobilisation and dc
- Pt gratification in VB
What are the risks of VBAC?
- Increased perinatal loss cf ERCS at 39 weeks (stillbirth, intrapartum death)
- Inc HIE risk
- Increased morbidity if emergency LUSCS cf ERCS
- Pelvic floor trauma
Uterine rupture vs uterine dehiscence?
- Rupture: complete separation of all layers of the uterine wall including the serosa. Free communication between uterus and abdominal cavity.
- Dehiscence: incomplete disruption of uterine wall. Usually serosa overlying defect in muscle. Often incidental findings at ERCS
