VBAC, C/S

Question 1

Best predictor of successful vbac?

Answer 1

Previous vaginal delivery

Question 2

Name advantages vbac (4)

Answer 2

Maternal

• success rate 72 - 75%; if successful - shorter hospital stay and recovery
• increase likelihood future vaginal birth
• lower maternal death 4/100 000
• lower risk transient respiratory morbidity

Question 3

Name disadvantages vbac (7)

Answer 3

Maternal

• 0,5% risk uterine rupture
• 5% Risk anal sphincter injury. Birth weight is strongest predictor. Rate instrumental delivery 39%
• higher risk pelvic organ prolapse and urinary incontinence

Foetal

• 2-3% risk transient respiratory morbidity
• 0,1% prospective risk of antepartum stillbirth beyond 39 weeks while awaiting spontaneous labour
• 0,8% risk hie
• 0,04% risk delivery related perinatal death

Question 4

Name 5 advantages elective repeat c/s after previous caesarean

Answer 4

Maternal

• able to plan known delivery date
• much lower risk uterine rupture (o, 02%)
• reduce risk pelvic organ prolapse + urinary incontinence
• Sterilisation option

Foetal

• much lower (<0,01%) risk delivery related perinatal death or hie

Question 5

Name 4 disadvantages elective repeat c/s after previous caesarean

Answer 5

Maternal

• longer recovery
• future pregnancies likely to require c/s with increased risk placenta praevia/accreta and adhesions
• risk of maternal death X 3.5 higher (14/100 000)
• 4-5% risk transient respiratory morbidity

Question 6

Name 4 contraindications vbac

Answer 6

• Previous uterine rupture
• classical caesarean scar
• other absolute contraindications to vaginal birth eg placenta praevia
• more than 2 prior lower segment caesarean