VBAC Flashcards
1
Q
Indications for Cesarean
A
- Umbilical cord prolapse
- CPD (baby too big)
- Placental abruption
- Placenta previa
- Fetal malpresentation
2
Q
VBAC
A
- Indications: previous low transverse uterine incision, no more than 2 previous cesareans
- MD/CNM must obtain informed consent
- Nursing considerations: large bore IV access, continuous EFM, increased risk for uterine rupture
3
Q
Advantages of VBAC
A
- Greater maternal satisfaction
- Quicker recovery
- Cheaper
- Less RDS for babies
- Less maternal morbidity and mortality
4
Q
Contraindications for VBAC
A
- Previous classical incision
- Previous two LSCS
- Previous CPD
- Previous extension of T
- Malpresentations
- Suspicion of CPD
- Medical/OB complication
- Multiple pregnancy
- Patient refusal
5
Q
Recommendations for selecting VBAC candidate
A
- Patient consent
- One previous low transverse cesarean
- Clinically adequate pelvis
- No other uterine scars or previous rupture
- Physician immediately available throughout labor
- Availability of anesthesia and personnel for emergency cesarean
6
Q
Increased chance of success
A
- Prior vaginal birth
- Prior VBAC
- Spontaneous labor
- Favorable cervix
- Nonrecurring indication
7
Q
Decreased chance of success
A
- Use of pitocin: higher risk of rupture
- Use of prostaglandins: higher risk of rupture (NOT RECOMMENDED)
- Maternal obesity
- Short stature
- Macrosomia
- Over 40 years old
- Induction of labor
- Preterm
- Recurring indications
8
Q
Nursing Implications for VBAC
A
- Access to OR available
- Monitor as high risk
- S/S of uterine rupture: patient complains of increased pain and tenderness even with epidural, may occur over time or suddenly, vomiting/syncope/vag bleeding/tachycardia/fetal bradycardia/absent FHR
9
Q
Nursing Care for VBAC
A
- Continuous EFM or IFM
- IV fluids
- Avoid pitocin if at all possible
- Important for nurse to provide support and info throughout labor
