205 - Vaginal Birth After Cesarean

Question 1

Risk of rupture with 1 prior low transverse cesarean?

Answer 1

0.5-0.9%

Question 2

ERCD vs. TOLAC: which was higher risk of infectious morbidity?

Answer 2

TOLAC (4.6 vs. 3.2%)

Question 3

ERCD vs. TOLAC: which was higher risk of surgical injury?

Answer 3

TOLAC (0.4-1.3 vs. 0.3-0.6%)

Question 4

ERCD vs. TOLAC: which was higher risk of blood transfusion?

Answer 4

TOLAC (0.66 vs. 0.46%)

Question 5

ERCD vs. TOLAC: which was higher risk of Hysterectomy

Answer 5

ERCD! (0.16 vs. 0.14%)

Question 6

ERCD vs. TOLAC: which was higher risk of maternal death?

Answer 6

ERCD! (0.01 vs. 0.002%)

Question 7

ERCD vs. TOLAC: which was higher overall fetal risks?

Answer 7

TOLAC, with exception of transient tachypnea of newborn

Question 8

TOLAC success rate?

Answer 8

60-80%

Question 9

Factors negatively influencing likelihood of VBAC?

Answer 9

Prior arrest, IOL, augmentation, older maternal age, higher BMI, >40wks gestation, short interdelivery interval (<19m), preelampsia

Question 10

Utility of VBAC calculators

Answer 10

Can predict who is a good candidate, but has not been shown to improve patient outcomes!…. But if 60-70% vs. 70% success rate, likely less maternal vs. fetal morbidity with TOLAC than ERCD…

Question 11

Who is NOT a good candidate for planned TOLAC?

Answer 11

1) Prior classical
2) extensive transfundal surgery
3) Prior uterine rupture
4) other contraindications to vaginal delivery

Question 12

Risk of rupture with 2 prior CD?

Answer 12

0.9-3.7%

Question 13

Success of VBAC with 2 prior CD?

Answer 13

same as 1, there are calculators that use this

Question 14

Macrosomia and TOLAC

Answer 14

decreased success, not a contraindication

Question 15

Low vertical scar -success, risks of TOLAC?

Answer 15

all appear similar to 1x LT CD

Question 16

Unknown scar - can they TOLAC?

Answer 16

Yes, unless you suspect prior classical i.e. extremely preterm prior CD

Question 17

Twin gestation and TOLAC - success, risks?

Answer 17

Same as singleton 1x prior CD

Question 18

Can you ECV a prior CD?

Answer 18

Yes

Question 19

Success rate of ECV in prior CD compared to unscarred uterus?

Answer 19

Same

Question 20

Most common sign of uterine rupture and in what % of cases do you see it?

Answer 20

FHT abnormalities, 70%

Question 21

Effect of epidural on TOLAC success

Answer 21

None

Question 22

Risk of recurrent rupture in subsequent pregnancy if LUS? Upper uterus?

Answer 22

LUS: 6%
Upper: 15-32%

Question 23

When and how to deliver viable prior uterine rupture?

Answer 23

36-36+6w by cesarean or sooner if in labor

Question 24

When can you use prostaglandins for a TOLAC?

Answer 24

2nd trimester (loss)

Question 25

Can you use prostaglandins for 3rd trimester IUFD?

Answer 25

No, use foley balloon

Question 26

What is the appropriate setting for a TOLAC

Answer 26

Level I center or higher (can do CD)

Homebirth conraindicated