VBAC Flashcards

1
Q

Who is suitable for a planned VBAC?

A

Majority of women with:

  • singleton pregnancy
  • cephalic pregnancy
  • 37+ weeks
  • single previous LUSCS
  • +/- history of vag birth
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2
Q

What are the contraindications to VBAC?

A
  • previous uterine rupture
  • classical caesarean
  • other absolute contraindications to vaginal birth irrespective of scar (i.e. praevia)
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3
Q

Can women with 2+ previous caesars be offered VBAC?

A
  • 2+ prior LUSCS may be offered VBAC after counselling by senior obstetrician
  • counsel re risk of rupture and maternal morbiditiy
  • individual likelihood of successful VBAC (e.g. previous vaginal delivery)
  • conducted in appropriate centre
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4
Q

What is the risk of uterine rupture with a planned VBAC?

A

1 in 200 (0.5%)

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5
Q

What should women be advised regarding risks in VBAC?

A
  • Successful VBAC has fewest complications
  • Absolute birth related death comparable for nulliparous women in labour
  • Emerg LUSCS after VBAC trial has most
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6
Q

VBAC success rate?

A

72 - 75%

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7
Q

What determines individual likelihood of successful VBAC?

A

-Previous vaginal delivery; VBAC success = 85-90%

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8
Q

Counselling re induction or augmentation of labour with VBAC?

A

-2-3x risk rupture
-1.5x risk caesarean
cf spontaneous VBAC labour

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9
Q

Where should VBAC be conducted?

A
  • staffed and equipped delivery facility
  • continuous intrapartum care and monitoring
  • resources for urgent LUSCS
  • advanced neonatal resuscitation
  • continous electronic foetal monitoring
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10
Q

Can women have epidural in VBAC?

A

Yes, not a contraindication

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11
Q

Which factors favour successful VBAC?

A
  • Previous safe vaginal birth
  • Previous successful VBAC
  • Spontaneous onset of labour
  • Uncomplicated pregnancy without other risk factors
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12
Q

Which factors reduce likelihood of successful VBAC?

A
  • Previous LUSCS for dystocia
  • Induction of labour
  • Coexisting foetal, maternal or placental conditions
  • Maternal BMI 30+
  • Foetal macrosomia 4kg+
  • Advanced maternal age
  • Short stature
  • 2+ previous LUSCS
  • RFx for scar rupture
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13
Q

What are the benefits of successful VBAC?

A
  • Less maternal morbidity
  • Avoid major surgery
  • Earlier mobilisation and dc
  • Pt gratification in VB
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14
Q

What are the risks of VBAC?

A
  • Increased perinatal loss cf ERCS at 39 weeks (stillbirth, intrapartum death)
  • Inc HIE risk
  • Increased morbidity if emergency LUSCS cf ERCS
  • Pelvic floor trauma
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15
Q

Uterine rupture vs uterine dehiscence?

A
  • Rupture: complete separation of all layers of the uterine wall including the serosa. Free communication between uterus and abdominal cavity.
  • Dehiscence: incomplete disruption of uterine wall. Usually serosa overlying defect in muscle. Often incidental findings at ERCS
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16
Q

What are the sequelae of uterine rupture?

A

-Foetal: death, academia, hypoxic insult
-Maternal: hysterectomy, blood transfusion
With appropriate management both mother and foetus usually health