Which is true?
a) uterine dehiscence requires ruptured membranes
b) uterine rupture always involves the fetus being outside of the uterus in the maternal abdomen
c) morbidity and mortality are significantly increased with a uterine dehiscence
d) if uterine rupture occurs, you should do a C/S
d
What success rate for TOLAC does ALARM quote?
64-76%
What factors increase the likelihood of a successful VBAC?
- previous successful VBAC
- c/s was for fetal reasons (breech, AFHR, etc)
- previous successful vaginal delivery
- favourable cervix, spontaneous labour
- maternal age < 40
What factors decrease the likelihood of a successful VBAC?
- EFW > 4kg
- cervix not favourable, no spontaneous labour
- prev C/S for dystocia, CPD,
- GA > 40 weeks
- age > 40
- BMI > 30, HTN
Which of the following is true?
a) risk of uterine rupture with TOLAC is about 0.4%
b) risk of uterine rupture with ERCS is about 0.026%
c) risk of cesarean hysterectomy if uterine rupture occurs is 15-30%
d) all of the above
d
What is your mgmt of a uterine rupture?
maternal stabilization, alert anaesthesia/NICU, prophylactic Abx
urgent laparotomy
control hemorrhage
urgent repair or C-hyst
What are the prerequisites to offering a TOLAC?
urgent C/S available (30 min response time)
protocol in place for how to respond to emergency
recognize signs/sx of rupture
anaesthesia/peds aware
What factors increase the risk of rupture?
< 18 month delivery interval single layer closure >2 prev c/s macrosomia hx of prev c/s for 2nd stage dystocia
Name 5 contraindications to TOLAC
- any contraindication to vaginal delivery
- previous uterine rupture
- hx classical or inverted T incision
- hx prev full-thickness uterine surgery
- inability to mount emergency c/s
- maternal request for ERCS
Which is not true?
- need for oxytocin induction is a relative contraindication to TOLAC
- chances of success are greatest with spontaneous labour
- prostaglandins are contraindicated
- Foley catheter is the recommended means of cervical ripening
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