VBACs Flashcards
low transverse cut
horizontal cut made across the lower, thinner part of the uterus
low vertical cut
vertical cut made on the lower thinner part of the uterus
high vertical cut
aka classical
vertical cut in the upper part of the uterus
has highest risk or rupture
what makes the trial of labor more successful?
nonrecurring causes for c-section (breech, fetal distress) prior vaginal delivery already having had a successful VBAC one on one labor support spontaneous labor admission to hospital later in labor
what makes the trial of labor less successful?
past CPD (although 50-70% of women with past c-section due to CPD have successful vaginal births) maternal obesity diabetes induction of labor macrosomia
benefits of VBAC
less morbidity Fewer blood transfusions Fewer post partum infections Shorter hospital stay No increase in perinatal morbidity Emotional advantages from achieving vaginal birth
maternal complications
uterine rupture
neonatal complications
Respiratory problems significantly higher in infants born by elective C-section, 6% with transient tachypnea- because fetal maturity is not proven before C- section is performed
Infants born after trial of labor have significantly more sepsis
Uterine rupture may cause death or neurological damage to the fetus, however neonatal outcomes do not differ from those born by repeat C-section without labor.
contraindications to VBAC
Prior classical incision or “T” scar Transfundal uterine surgery Contracted pelvis Inability to perform emergency C-section Other medical or obstetrical contraindications for vaginal delivery
relative contraindications
Multiple low transverse incisions form previous C-sections Unknown uterine scar Breech presentation Twin gestation Post term pregnancy Suspected macrosomia
which induction drug is contraindicated in prior c-section or prior uterine surgery?
cytotec
which induction drug is associated with high risk of uterine rupture in VBACs?
prostaglandin
