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FRANZCOG OBSTETRICS > VBAC (RANZCOG) > Flashcards

VBAC (RANZCOG) Flashcards

1
Q

Incidence of LSCS in Australia and NZ?

A

33% Aus, 25.5% NZ 2015

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2
Q

Prepregnancy advice to increase success and safety of VBAC?

A

IP interval of 18 months

weight reduction

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3
Q

Success rates of VBAC?

A

60-80% success Middlemore

43% Aus

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4
Q

Factors favouring successful VBAC?

A

previous safe vaginal birth
previous successful VBAC (87-91%)
spontaneous onset labour
uncomplicated low risk pregnancy

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5
Q

Factors reducing VBAC success?

A 
Previous CS for dystocia
IOL
coexisting pregnancy/maternal conditions
BMI >30 (40%)
macrosomia >4kg
AMA
short stature
>1 CS
Postdates (RCOG)
low pre labour bishop score (RCOG)
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6
Q

What is the difference in incidence of uterine rupture when BMI normal vs. >40? (RANZCOG)

A
  1. 9% normal BMI

2. 1% BMI >40

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7
Q

RDS risk VBAC vs. CS

A

RCOG
VBAC = 2-3%
CS = 4-6%

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8
Q

difference in maternal mortality for VBAC or repeat CS?

A

VBAC = 0.004%
CS = 0.013%
RCOG

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9
Q

Uterine rupture rate in unscarred vs. scarred uterus? (RANZCOG)

A
  1. 5-2/10,000 deliveries in unscarred uterus
  2. 005-0.02%

vs.

22-74/10,000 deliveries
0.2-0.7%

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10
Q

risk of pathological fetal acidosis after uterine rupture (RANZCOG)

A

0.15% of VBAC

90% after uterine rupture.

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11
Q

Risk of perinatal death with uterine rupture (RANZCOG)

A

4 per 10,000 (0.04%) 1/3 attributable to uterine rupture

Elective cs = <1/10,000 perinatal death

Risk after uterine rupture is 12% (UKOSS), 2-16% AHRQ

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12
Q

risk of maternal death with uterine rupture (RANZCOG)?

A

UKOSS: 1.3% with uterine rupture.

RANZCOG: 0.02 per 1000 women attempting VBAC (2/100,000)
0.002%

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13
Q

What is the risk of uterine rupture with previous classical Caesarean, inverted T or J incisions? (RANZCOG)

A

classical= 20-90/1000 (2-9%)
T or J= 19/1000 (1.9%)

(vs. 5-7/1000 for lower segment transverse)
(0. 5-0.7%)

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14
Q

Incidence of placenta accreta in 1st, 2nd, 3rd, 4th, 5th 6th or more CS?

A 
1= 0.24%
2= 0.31%
3= 0.57%
4= 2.1%
5= 2.3%
6 or more = 6.7%
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15
Q

Complication rate of elective vs. emergency CS?

A 
elective = 7%
emergency = 13.2%
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16
Q

Rates of emCS after for VBAC in in induced, augmented, and spontaneous labour groups?

A 
induced = 33% CS (at least)
augmented = 26% CS 
spontaneous = 18%
17
Q

Risk of uterine rupture with prostaglandin IOL? R

A

prostaglandin: 1.4-2.45%

18
Q

What is the risk of uterine rupture in women augmented with VBAC vs. no augmentation?

A

augmentation = 1.9%

no augmentation = 0.19%

19
Q

What is the risk of uterine rupture after foley balloon and ARM in VBAC?

A
  1. 3/1000 women (0.8-22.4)

0. 63%

20
Q

Risk of uterine rupture with any induction method?

A

12/1000 (9-16)

1.2%

21
Q

What is the success rate of VBAC after second CS compared to after first? What are the rates of uterine rupture?

A

71% vs. 77% success

rupture rate 1.6% vs. 0.7%

21
Q

What is the success rate of VBAC after second CS compared to after first? What are the rates of uterine rupture?

A

71% vs. 77% success

rupture rate 1.6% vs. 0.7%

22
Q

What is the rate of mid trimester VBAC uterine rupture with misoprostol induction?

A
  1. 04% no CS vs.

0. 28% CS

23
Q

Contraindications to VBAC?

A

T or J incisions.
Previous uterine surgery (myomectomy)
Previous uterine rupture
placenta praevia

24
Q

VBAC success, uterine rupture rate and maternal morbidity after 2 previous CS?

A
  1. success 71.1%
  2. uterine rupture 1.36%
  3. hysterectomy 56/10,000 (0.6%) vs. 19/10,000 (0.2%),
  4. transfusion 1.99% vs. 1.21%
25
Q

What is the risk of maternal death with planned VBAC vs. elective CS?

A

4/100,000 VBAC (0.004%)

13/100,000 planned CS (0.013%)

26
Q

What is the risk of transient respiratory morbidity in VBAC vs. elective CS?

A

2-3% VBAC

4-5% LSCS

27
Q

Contrast foley IOL and prostaglandin induction for VBAC

a) risk of uterine rupture
b) success

A

Foley IOL +ARM

a) 0.63%
b) 54-61%

Prostaglandin only

a) 0.7-2.0% (up to 2.45%)
b) 51-63%

Prostaglandin + Oxytocin

a) 1.8% (must be more)
b) 60.2%

28
Q

Rate of VBAC success with EFW >4kg, no previous vaginal delivery?

A

Less than 50%, increased uterine rupture rate 3.6%

29
Q

Risk of hysterectomy when attempting VBAC?

A

0.5-2/1000 women attempting VBAC

9% if uterine rupture occurs (UKOSS)

30
Q

Risk of genitourinary injury in women attempting VBAC?

A

0.8 per 1000 women attempting VBAC

31
Q

Risk of uterine rupture in term and post term IOL (RANZCOG)

A 
term = 1.5%
post-term = 3.2%
32
Q

Success rate of twin VBAC delivery?

A

3x small studies
64-76%
no increase in scar rupture or perinatal morbidity

largest study reported
uterine rupture 0.9%
success 45%

33
Q

Overall major maternal and perinatal morbidity in attempting VBAC?

A 
perinatal  = 1/1000 attempting VBAC
maternal = 3/1000 attempting VBAC
34
Q

Risk of perinatal mortality postdates spontaneous VBAC?

A

1.8/1000
= 0.4 due to uterine rupture
= 1.4 due to postdates

Ranzcog guideline

35
Q

UKOSS perinatal morbidity and mortality after uterine rupture?

A

12% mortality
41% admitted nicu median 3 days
6% encephalopathy

36
Q

Risk of HIE VBAC vs. elective CS?

A

RCOG=
VBAC= 0.08%. 60% due to uterine rupture.
CS = <0.01%

37
Q

Risk of delivery prior to 39 weeks?

A

10%

FRANZCOG OBSTETRICS (25 decks)

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