VBAC

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Author:
JMC
ID:
265957
Filename:
VBAC
Updated:
2014-03-11 14:06:51
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VBAC
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Description:
VBAC Material for NM 622
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  1. ACOG Selection Criteria for VBAC
    • 1-2 previous CS
    • Singleton
    • Cephalic presentation
    • Spontaneous labor
    • Hx VBAC/vaginal birth
    • Clinically adequate pelvis
    • CS hx for fetal distress, malpresentation (not dystocia)
    • No other hx of uterine scar, rupture or OB/GYn complication that precludes VBAC
  2. VBAC Success Rate
    60-80%
  3. Risk for Uterine Rupture with hx of one low, transverse incision
    • 3.2/1000
    • (Similar to general r/f abruption, prolapse)
  4. TOL (vs. ERCD) for Uterine Rupture
    • higher risk of UR (3.2/1000) vs ~zero for CS
    • hysterectomy (14-33%) if UR
    • fetal death (6%) if UR
    • no maternal deaths assoc. with UR (vs gen. TOL of 1.9/100,000)

  5. TOL (vs. ERCD) for Perinatal Morbidity/Mortality
    • Perinatal mortality (1:1000) - only slightly higher than other high-risk pregnancies (2:1000 for HTN)
    • HIE may be higher (8:10,000) - one study; higher in failed TOL vs. anything else
    • ST complications are generally the same as nullips
  6. ERCD (vs. TOL): General
    • Higher risk for mom, lower for baby (overall)
    • Maternal death (9.6/100,000)
    • HIE (0:10,000)
    • Perinatal mortality (0.5:1,000 vs. 1.3:1,000 for genTOL
  7. ERCD (vs. TOL): Mother ST
    • Post-op healing
    • Bowel/bladder injury
    • Infection
    • Longer hospital stay
    • PPH risk higher than TOL
    • Transfusion & reaction
    • Death
  8. ERCD (vs. TOL): Mother LT
    • Downstream effect for future pregnancies
    • - previa
    • - accreta
    • - CS
    • Adhesions
    • Chronic pain
    • Infertility/Stillbirth
  9. ERCD (vs. TOL): Fetus/Neonate ST
    • HIE (0:10,000)
    • Perinatal mortality (0.5:1000 vs. 1.3:1000 gTOL
    • More respiratory issues in general with CS vs. vag.
    • Delayed BF initiation, delayed bonding, difficulty with latch & attachment
  10. Use of oxytocin in VBAC
    • Does NOT appear to increase UR risk when used ALONE
    • Do not use with PgE2 sequentially
    • Data is mixed re: use for augmentation
  11. Misoprostol and VBAC
    • Contraindicated with history of uterine scar
    • Do not use with other PgE's for ripening
  12. Data regarding VBAC
    • Overall data is insufficient
    • Cannot accurately determine risk (sepsis, HIE, respiratory morbidity, apgar scores) due to confounding variables
    • Defining UR vs. dehiscence vs. infection differs between studies
  13. Pros for VBAC
    • Avoid major surgery
    • Quicker recovery
    • Lower PPH
    • Lower infection
    • Lower r/f CS in future
    • Least complications if successful

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