Flashcards in VBAC Deck (16)
Who is suitable for a planned VBAC?
Majority of women with:
-single previous LUSCS
-+/- history of vag birth
What are the contraindications to VBAC?
-previous uterine rupture
-other absolute contraindications to vaginal birth irrespective of scar (i.e. praevia)
Can women with 2+ previous caesars be offered VBAC?
-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
What is the risk of uterine rupture with a planned VBAC?
1 in 200 (0.5%)
What should women be advised regarding risks in VBAC?
-Successful VBAC has fewest complications
-Absolute birth related death comparable for nulliparous women in labour
-Emerg LUSCS after VBAC trial has most
VBAC success rate?
72 - 75%
What determines individual likelihood of successful VBAC?
-Previous vaginal delivery; VBAC success = 85-90%
Counselling re induction or augmentation of labour with VBAC?
-2-3x risk rupture
-1.5x risk caesarean
cf spontaneous VBAC labour
Where should VBAC be conducted?
-staffed and equipped delivery facility
-continuous intrapartum care and monitoring
-resources for urgent LUSCS
-advanced neonatal resuscitation
-continous electronic foetal monitoring
Can women have epidural in VBAC?
Yes, not a contraindication
Which factors favour successful VBAC?
-Previous safe vaginal birth
-Previous successful VBAC
-Spontaneous onset of labour
-Uncomplicated pregnancy without other risk factors
Which factors reduce likelihood of successful VBAC?
-Previous LUSCS for dystocia
-Induction of labour
-Coexisting foetal, maternal or placental conditions
-Maternal BMI 30+
-Foetal macrosomia 4kg+
-Advanced maternal age
-2+ previous LUSCS
-RFx for scar rupture
What are the benefits of successful VBAC?
-Less maternal morbidity
-Avoid major surgery
-Earlier mobilisation and dc
-Pt gratification in VB
What are the risks of VBAC?
-Increased perinatal loss cf ERCS at 39 weeks (stillbirth, intrapartum death)
-Inc HIE risk
-Increased morbidity if emergency LUSCS cf ERCS
-Pelvic floor trauma
Uterine rupture vs uterine dehiscence?
-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