VBAC Flashcards
What are risks of VBAC?
Risk of uterine rupture
Risk of anal sphincter injury
Risk of maternal death
Risk of transient respiratory difficulties for the neonate
Risk of hypoxic ischaemic encephalopathy to the neonate
Risk of stillbirth beyond 39 weeks whilst awaiting spontaneous labour
What are benefits of VBAC?
If successful, shorter hospital stay and recovery
If successful good change of successful future VBACs
Lower risk of maternal death than C-section
What are risks of elective repeat C-section?
Longer recovery
Higher risk fo maternal death
Subsequent pregnancies likely to require C-section
Risk of neonatal respiratory morbidity
Risk o placenta problems (accreta and praevia) and adhesion formation
What is uterine rupture?
Full-thickness disruption of the uterine muscle and overlying serosa
Fetus can be extruded from the uterus resulting in fetal hypoxia and large internal maternal haemorrhage
Previous C-section is biggest risk factor
What are risk factors for uterine rupture in VBAC?
Previous C-section - vertical incisions higher risk
Previous uterine surgery - myomectomy
Induction - particularly with prostaglandins or augmentation of labour
Obstruction of labour
Multiple pregnancy
Multiparity
How should women undergoing VBAC be managed?
Deliver ins Setting with facilities for emergency C-section
Continuous CTG monitoring
Additional analgesic requirements may indicate impending uterine rupture
Avoid induction where possible - use mechanical techniques (e.g. amniotomy) when required
Be cautious with augmentation
When is elective repeat C-section recommended?
After 39 weeks, elective repeat C-section is recommended
What are absolute contraindications for VBAC?
Classical C-section scar
Previous uterine rupture
Placenta praevia and other CI for vaginal birth
What are relative contraindications for VBAC?
Complex uterine scar
>2 prior lower segment Caesarean sections
