VBAC

Question 1

Who is VBAC appropriate for?

Answer 1

1- single fetus in longitudinal lie, cephalic-vertex presentation, with occipito-anterior position

2- young, low parity, at 37-40 weeks, EFW <3.5kg

3- single lower segment CS (18 months ago due to non-recurrent cause) with myometrial thickness at scar 2.1mm or more

4- availability of CTG & facility for possible CS/hysterectomy

Question 2

What are the contraindications for VBAC?

Answer 2

1- maternal age > 40
2- BMI > 35
3- history of uterine rupture, upper segment CS, T-shaped uterine incision, hysterotomy, myomectomy, or LSCS 2 or more
4- myometrial thickness at previous scar < 2.1mm
5- post dated pregnancy, macrosomia, IUFD, malposition, malpresentation, multifetal pregnancy
6- non-availability of CTG or facility of CS/hysterectomy
7- women who have other contraindications (Previa, HF)

Question 3

What is the best predictor of a successful VBAC?

Answer 3

A previous successful VBAC

Question 4

What should be done at the delivery from during VBAC?

Answer 4

1- epidural can be given but stay alert for impending rupture
2- continuous CTG starting from onset of true labour pains
3- induction of labour should only be done using mechanical methods (PGE1 + oxytocin is associated with 2 - 3 folds increased risk of uterine rupture)

Question 5

What are the alarming signs for scar rupture?

Answer 5

1- sudden severe abdominal pain with scar tenderness
2- abnormal unexplained vaginal bleeding + hematuria
3- maternal tachycardia, hypotension, fainting or shock
4- abnormal CTG (prolonged deceleration)
5- cessation of uterine activity
6- Loss of station
7- change in abdominal contour
8- inability to find fetal pulsation

Question 6

How is uterine rupture treated?

Answer 6

1- ABC & resuscitation
2- exploratory laparotomy
- extract fetus & placenta
- if the site of the previous scar is clean -> repaired the uterus
- hysterectomy