vbac_flashcards
What is the success rate of Vaginal Birth After C-section (VBAC)?
72-75%
How does the number of successful VBACs affect future success rates?
Increased number of successful VBACs increases future success rate: 2nd VBAC ~80%, 3rd VBAC ~90%
What factors are associated with increased success of VBAC?
Previous successful VBAC, previous vaginal delivery, spontaneous onset of labour, normal size baby, vertex presentation, singleton pregnancy
What is the risk of uterine rupture in VBAC?
1 in 200 (increased to 1 in 100 with the use of syntocinon)
What are the benefits of VBAC?
Avoiding a further CS and its implications on future pregnancies, increasing likelihood of success of future vaginal births, having the fewest complications if successful
What is required if VBAC is unsuccessful?
Emergency C-section
What are the risks associated with Elective Repeat C-section (ERCS)?
Implications on future pregnancies, risk of placenta praevia/accreta, risk of pelvic adhesions complicating future abdominopelvic surgery
What are the benefits of Elective Repeat C-section (ERCS)?
Avoids risk of uterine scar rupture and emergency CS
What monitoring is required for VBAC?
Continuous foetal monitoring
What is the increased risk if IOL is needed for VBAC?
2-3 fold increased risk of uterine rupture, lower risk with mechanical IOL than with prostaglandins
What are the relative contraindications for VBAC?
≥2 previous C-sections, need for IOL, previous labour outcome suggestive of cephalopelvic disproportion
What are the absolute contraindications for VBAC?
Previous classical C-section, previous uterine rupture, other absolute contraindications to vaginal birth such as placenta praevia
What should be discussed with the patient regarding birth options after a C-section?
Elective repeat C-section (ERCS) or attempted vaginal birth after C-section (VBAC)
What are the risks of VBAC?
Uterine rupture risk of 1 in 200, success rate 70-75%, remainder require emergency CS
What are the risks of ERCS?
Implications for future pregnancies
