VBAC

Question 1

Factors favoring success

Answer 1

Previous vaginal birth
Previous successful vbac
Spontaneous labour
Uncomplicated pregnancy

Question 2

Reducing success in vbac

Answer 2

Previous cs for dystocia
IOL
Coexisting fetal, placental or maternal conditions
Maternal BMI >30
Fetal macrosomia of >4kg
AMA
short stature
More than one cs
Risk factors associated with an increased risk of scar rupture

Question 3

Risk of uterine rupture

Answer 3

0.9%

Risk of rupture 2.1% if BMI >40

Question 4

Risks with VBAC

Answer 4

Increased perinatal loss
HIE risk (0.7 per 1000)
Increased mobility of emcs
Pelvic floor trauma
Superficial skin lac to baby (2%)

Question 5

Risk of scar rupture with short IPI

Answer 5

2-3 fold increase (2.3-4.8) if 18 months or 24 months

Question 6

Risks with c section

Answer 6

Surgical risk increasing with each Caesarean section (PPH, hysterectomy, bladder and bowel injury and requirement for post op ventilation

Question 7

Risk of accreta with caeser

Answer 7

1. 0.24
2. 0.31
3. 0.57
4. 2.1
5. 2.3
6. 6.7

Question 8

Signs of uterine rupture

Answer 8

Abnormal CTG
Severe abdominal pain persisting between contractions
Chest pain or shoulder tip pain
Sudden onset SOB
Acute onset of scar tenderness
Abnormal vaginal bleeding or haem at iris
Cessation of previous efficient uterine activity
Maternal tachycardia, hypotension, or shock
Loss of station of the presenting part

Question 9

Risk of rupture with augmentation

Answer 9

14 fold increased risk over spontaneous labour