TOLAC

Question 1

TOLAC vs CS

• EBL
• infection
• VTE risk
• recovery time
• OB complications

Answer 1

avoid surgery
reduced blood loss
decreased infection
decreased VTE
shorter recovery time
fewer OB complications in subsequent pregnancies (abruption, previa, accreta)

Question 2

TOLAC disadvantages

Answer 2

Risk of TOLAC failure (aka complications of a CS)
rupture/dehiscence
- 0.5-1.0% risk after 1 CS
- risk increased if had supper uterine segment surgery too (hx classical)
- rupture is CI to future TOLAC

Question 3

MC sign of uterine rupture

Answer 3

fetal heart rate tracing abnormalities

Question 4

Recommend consider against TOLAC when 70% success plus…

Answer 4

prior CS for arrest of labor or dystocia
IOL or augmentation with prior pregnancy
AMA
BMI >30
GA >40
EFW current pregnancy 4000-4500g
PreEclampsia
SIP (<19m)

Question 5

TOLAC with prior SVD increases/decreases probability of successful TOLAC

Answer 5

increases

Question 6

prediction models for TOLAC

Answer 6

do no improve outcomes

Question 7

TOLAC okay after how many CS

Answer 7

1 and 2

Question 8

TOLAC after undocumented scar

Answer 8

okay because risk of prior classical is very small (unless very early GA, then would be contraindicated)

Question 9

TOLAC and twins

Answer 9

okay

Question 10

IOL and augmentation with TOLAC

Answer 10

• increases risk for uterine rupture, but unknown how much etc
• therefore pit is okay in with TOLAC

Question 11

TOLAC and cerivcal rippening

Answer 11

• mechanical or transcervical catheter is not associated with increased rupture risk, okay
• misoprostol (PgE1) is not acceptable in TOLAC in 3rd trimester
• misoprostoal is okay in TOLAC 2nd delivery

Question 12

ECV and TOLAC

Answer 12

okay, not CI

Question 13

TOLAC and epidural

Answer 13

okay