VBAC

Question 1

What is the risk of scar rupture during VBAC?

Answer 1

5-7/1000

Question 2

What is the risk of catastrophic outcome for mum or baby in event of uterine scar rupture?

Answer 2

1:7

Question 3

What are the 1st three Ranzcog recommendations regarding counselling re: VBAC?

Answer 3

• shortly postpartum after a primary CS women should have a debrief to discuss delivery with team + implications for future pregnancies
• women with a h/o otherwise uncomplicated CS should have the option to discuss VBAC vs ERCS in antenatal course
• The risks and benefits of birth options should be discussed with a patients individual risk/chances of successful VBAC discussed + leaflet provided

Question 4

What does attempt at VBAC require practically?

Answer 4

• delivery in birth suite
• IV leur + bloods off
• CEFM
• adequately staffed unit
• access to EM CS promptly

Question 5

What does attempt at VBAC require practically?

Answer 5

• delivery in birth suite
• IV leur + bloods off
• CEFM
• adequately staffed unit
• access to EM CS promptly

Question 6

List 4 factors that favour success re: VBAC?

Answer 6

• previous safe vaginal birth
• previous successful VBAC
• spontaneous onset of labour
• uncomplicated pregnancy without other risk factors

Question 7

List 8 risk factors that indicate less chance of success with VBAC

Answer 7

• previous CS for labour dystocia
• IOL
• co-existing fetal, placental or maternal conditions
• maternal BMI >30
• fetal macrosomia >4kg
• advanced maternal age
• short stature
• more than 1 previous CS

Question 7

List 8 risk factors that indicate less chance of success with VBAC

Answer 7

• previous CS for labour dystocia
• IOL
• co-existing fetal, placental or maternal conditions
• maternal BMI >30
• fetal macrosomia >4kg
• advanced maternal age
• short stature
• more than 1 previous CS

Question 8

List 4 benefits of VBAC if successful vaginal delivery

Answer 8

• less maternal morbidity for index and future pregnancies
• avoidance of major surgery and multiple Caesarean sections in future pregnancy
• earlier mobilisation and discharge from hospital
• patient gratification in achieving vaginal birth if this is desired

Question 9

What are 4 risks associated with VBAC

Answer 9

• increased perinatal loss cf with ERCS at 39/40 (1.8/1000)
• stillbirth after 39/40 (due to longer gestation)
• intrapartum death or neonatal death (due to scar rupture in labour)
• HIE risk (0.7/1000)
• increase morbidity of emergency CS cf ERCS if unsuccessful
• pelvic floor trauma