GTG 45 Birth after caesarean section

Question 1

What is the percentage risk of uterine rupture in a planned VBAC?

Answer 1

Planned VBAC is associated with an approximately 1 in 200 (0.5%)
risk of uterine rupture.

Question 2

What is the success rate of planned VBAC?

Answer 2

the success rate of planned VBAC is 72–75%.

Question 3

What is the success rate of a planned VBAC in a women with one or more previous vaginal births?

Answer 3

Women with one or more previous vaginal births should be informed that previous vaginal delivery,
particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a
planned VBAC success rate of 85–90%. Previous vaginal delivery is also independently associated
with a reduced risk of uterine rupture.

Question 4

What is the risk of uterine rupture in induced and/or augmented labour compared with
spontaneous VBAC labour?

Answer 4

Women should be informed of the two- to three-fold increased risk of uterine rupture and around
1.5-fold increased risk of caesarean delivery in induced and/or augmented labour compared with
spontaneous VBAC labour.

Question 5

What is the risk of caesarean delivery in induced and/or augmented labour compared with
spontaneous VBAC labour?

Answer 5

1.5-fold increased risk of caesarean delivery in induced and/or augmented labour compared with
spontaneous VBAC labour.

Question 6

Risk of anal sphincter injury in VBAC?

Answer 6

5%

Question 7

Risk of instrumental delivery in VBAC?

Answer 7

39%

Question 8

Risk of maternal death in VBAC vs ERCS?

Answer 8

VBAC- Risk of maternal death with planned VBAC of
4/100 000;
ERCS- Risk of maternal death with ERCS of
13/100 000

Question 9

Risk of HIE in VBAC vs ERCS?

Answer 9

VBAC- 8 per 10 000 (0.08%) risk of hypoxic ischaemic
encephalopathy (HIE).
ERCS: < 1 per 10 000 (< 0.01%) risk of delivery-
related perinatal death or HIE

Question 10

Risk of transient neonatal respiratory morbidity in VBAC vs ERCS

Answer 10

VBAC 2-3%;
ERCS 4-5%; 6% risk if delivery performed at 38
instead of 39 weeks

Question 11

What are the signs of uterine rupture?

Answer 11

• abnormal CTG
• severe abdominal pain, especially if persisting between contractions
• acute onset scar tenderness
• abnormal vaginal bleeding
• haematuria
• cessation of previously efficient uterine activity
• maternal tachycardia, hypotension, fainting or shock
• loss of station of the presenting part
  -change in abdominal contour and inability to pick up fetal heart rate at the old transducer site.
• scar dehiscence may be asymptomatic in up to 48%

the classic triad of a complete uterine rupture (pain, vaginal bleeding, fetal heart
rate abnormalities) may present in less than 10% of cases

Question 12

Risk of uterine rupture in an unscarred uterus ?

Answer 12

2 per 10 000 (0.02%)

The risk of uterine rupture in an unscarred uterus is extremely rare at 2 per 10 000 (0.02%)
deliveries and this risk is mainly confined to multiparous women in labour.

in planned VBAC is approximately 20–50 per 10 000 (0.2–0.5%) and in ERCS
the risk is 2 per 10 000 (0.02%)

Question 13

What is the risk of stillbirth at 39 weeks in women with a previous caesarean delivery vs without?

Answer 13

The risk of stillbirth at or after 39 weeks is between 1.5- and 2-fold higher in women with previous caesarean delivery compared with women without
previous caesarean delivery (absolute risks 11 per 10 000 [0.11%] versus 5 per 10 000 [0.05%])

Question 14

What is the VBAC success rate for women with an antepartum stillbirth and previous CS?

Answer 14

Women with an antepartum stillbirth and a previous caesarean delivery undergo labour with
a high VBAC success rate (87%)

Question 15

What is the risk of needing a blood transfusion in VBAC vs ERCS?

Answer 15

VBAC 2 per 100/2%; ERCS 1 per 100/1%