13 - Obs - Labour - Vaginal Delivery after previous C-section (VBAC) Flashcards Preview

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Flashcards in 13 - Obs - Labour - Vaginal Delivery after previous C-section (VBAC) Deck (5):
1

Contraindications

Inc usual absolute contraindications for c section, a ? uterine ? and ? prev c secs. After ? c secs, vaginal delivery seldom attempted in ??.

vertical
scar
multiple
2
UK

2

Factors influencing Vaginal Delivery after 1 C section

Prediction of success: If vaginal deliv attempted, ?-?% women will deliv, others req ? c section in ?. Prediction of success not ?.

Factors incr success: ? labour, inter preg interval less than ?, low ? and ?, ?, prev ? deliv (90% chance) and when prev c section was done ?/for fetal ?. ? subsequent fetus and engagement of head are ? prognostic features.

60-80%
emergency
labour
reliable

spont
<2y
age
BMI
Caucasian
vaginal
electively
distress
smaller
good

3

Maternal risks of VBAC

Related to chance of ? deliv – vaginal deliv is ?, emergency c sec ? safe, elective in between. So when attempting VBAC maternal safety depends on chance of ? delivery. Risk of ? and uterine ? higher w VBAC. Serious maternal morb greater w ? ? of prior c secs, risk of placenta ?.

vaginal
safest
least
emergency
transfusion
infection
incr no.
accreta

4

Fetal Risks of VBAC
Risk incr (3-10x) w VBAC. Largely as ? c sec at ?wks eliminates risk of antepartum ? beyond that time. Risk of VBAC itself is ?, usual rare risks of labour and ? of old uterine ?. Occurs in 0.7% VBAC attempts, approx. 10% perinatal mort. Risk higher w ? VBAC (emergency c sec) and if ??s/oxytocin used. Risk of stillbirth related to VBAC is ?. ? ? ? more common w elective c sec. Fetal morb incr w incr no of ? ??

elective
39
stilllbirth
small
rupture
scar
unsuccessful
PGs
low
Transient tachypnoea of the newborn TTN
prior C/s

5

Management of Labour after a C section

Delivery in hosp w ???monitoring due to risk of scar ?. ? avoided as incr risk of scar rupture. C sec preferable unless cervix ? or fetal head ?. ? also incr risk of scar rupture, done w caution. ? is safe, but labour shouldn’t be ?. Scar rupture presx as fetal ?, scar ?, cessation of ?, ?? bleed and maternal ?. Immed ? and C sec done if rupture suspected

CTG
rupture
induction
ripe
engaged
augmentation
epidural
prolonged
distress
pain
contractions
PV
collapse
laparatomy

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