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Flashcards in VBAC Deck (16):
1

Who is suitable for a planned VBAC?

Majority of women with:
-singleton pregnancy
-cephalic pregnancy
-37+ weeks
-single previous LUSCS
-+/- history of vag birth

2

What are the contraindications to VBAC?

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

3

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

4

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

1 in 200 (0.5%)

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

6

VBAC success rate?

72 - 75%

7

What determines individual likelihood of successful VBAC?

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

8

Counselling re induction or augmentation of labour with VBAC?

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

9

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

10

Can women have epidural in VBAC?

Yes, not a contraindication

11

Which factors favour successful VBAC?

-Previous safe vaginal birth
-Previous successful VBAC
-Spontaneous onset of labour
-Uncomplicated pregnancy without other risk factors

12

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
-Short stature
-2+ previous LUSCS
-RFx for scar rupture

13

What are the benefits of successful VBAC?

-Less maternal morbidity
-Avoid major surgery
-Earlier mobilisation and dc
-Pt gratification in VB

14

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

15

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

16

What are the sequelae of uterine rupture?

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