VBAC

Question 1

Success rate of VBAC after one previous section?

Answer 1

72-75%

Question 2

Success rate of VBAC in women with a previous vaginal delivery?

Answer 2

85-90%

Question 3

Factors that decrease the likelihood of success of VBAC? (7)

Answer 3

• no previous vaginal birth
• BMI >30
• AMA
• pregnancy interval >10 years
• dystocia previous indication
• EFW >4kg
• induction of labour

Question 4

Benefits of VBAC(4)

Answer 4

• reduction in neonatal respiratory issues (2-3% vs 4-5%)
• less maternal fever
• decreased risk of maternal death( 4 vs 13 : 100000
• increased future vaginal births

Question 5

Benefits of ERCS (4)

Answer 5

• decreased risk of uterine rupture ( 0.02 vs 0.5%)
• decreased risk of fetal trauma(0 vs .8hie .4death)
• less risk of pph requiring transfusion ( 10 vs 17 : 1000)
• less peripartum endometritis ( 15 vs 29: 1000)…compared to emergency section for failed tolac

Question 6

What is the first sign of uterine rupture?

Answer 6

Abnormal ctg ( 66- 76% of cases)

Question 7

Other signs of uterine rupture (9)

Answer 7

• severe abdominal pain between contractions
• chest or shoulder tip pain
• acute scar tenderness
• vaginal bleeding or haematuria
• cessation of uterine contractions
• maternal tachycardia and hypotension
• loss of fetal station
• change in contour of abdomen
• inability to detect fetal heart at previous location

Question 8

Risk of uterine rupture with VBAC

Answer 8

0.2- 0.5%

Question 9

VBAC success rate after previous for malpresentation

Answer 9

84%

Question 10

VBAC success- prev labour dystocia

Answer 10

64%

Question 11

Risk of OASIS with VBAC

Answer 11

5%

Question 12

What is the risk of cesarean section with induction- TOLAC

Answer 12

1.5 increased risk

Question 13

What is the risk of uterine rupture with induction - TOLAC

Answer 13

2-3x increased compared to spontaneous labour