VBAC

Question 1

Indications for Cesarean

Answer 1

• Umbilical cord prolapse
• CPD (baby too big)
• Placental abruption
• Placenta previa
• Fetal malpresentation

Question 2

VBAC

Answer 2

• Indications: previous low transverse uterine incision, no more than 2 previous cesareans
• MD/CNM must obtain informed consent
• Nursing considerations: large bore IV access, continuous EFM, increased risk for uterine rupture

Question 3

Advantages of VBAC

Answer 3

• Greater maternal satisfaction
• Quicker recovery
• Cheaper
• Less RDS for babies
• Less maternal morbidity and mortality

Question 4

Contraindications for VBAC

Answer 4

• Previous classical incision
• Previous two LSCS
• Previous CPD
• Previous extension of T
• Malpresentations
• Suspicion of CPD
• Medical/OB complication
• Multiple pregnancy
• Patient refusal

Question 5

Recommendations for selecting VBAC candidate

Answer 5

• Patient consent
• One previous low transverse cesarean
• Clinically adequate pelvis
• No other uterine scars or previous rupture
• Physician immediately available throughout labor
• Availability of anesthesia and personnel for emergency cesarean

Question 6

Increased chance of success

Answer 6

• Prior vaginal birth
• Prior VBAC
• Spontaneous labor
• Favorable cervix
• Nonrecurring indication

Question 7

Decreased chance of success

Answer 7

• Use of pitocin: higher risk of rupture
• Use of prostaglandins: higher risk of rupture (NOT RECOMMENDED)
• Maternal obesity
• Short stature
• Macrosomia
• Over 40 years old
• Induction of labor
• Preterm
• Recurring indications

Question 8

Nursing Implications for VBAC

Answer 8

• Access to OR available
• Monitor as high risk
• S/S of uterine rupture: patient complains of increased pain and tenderness even with epidural, may occur over time or suddenly, vomiting/syncope/vag bleeding/tachycardia/fetal bradycardia/absent FHR

Question 9

Nursing Care for VBAC

Answer 9

• Continuous EFM or IFM
• IV fluids
• Avoid pitocin if at all possible
• Important for nurse to provide support and info throughout labor