Counselling women about the risks of caesarean delivery in future pregnancies PART 3

^{Unfavourable factors for VBAC (VAGINAL BIRTH AFTER CAESAREAN DELIVERY)}

• ^{Recurrence of the previous indication for the initial CD (eg; labour dystocia).}
• ^{Gestational age greater than 40 weeks.}
• ^{Maternal obesity.}
• ^{Pre-eclampsia.}
• ^{Short interpregnancy interval.}
• ^{Increased maternal age.}
•  ^{non-white ethnicity.11}
•  ^{Advantages of TOLAC & successful VBAC}

• ^{It reduces the rate of blood transfusion.}
• ^{It reduces rate of hysterectomy.}
• ^{It reduces rate of neonatal respiratory morbidity.}
• ^{It helps to avoid major abdominal surgery.}
• ^{Shorter time to recovery.}
• ^{Less morbidity from infection.}
• ^{It reduces risk of abnormal placentation in future  pregnancies. Advantages of repeat CD}

• ^{Uterine rupture is rare.}
• ^{Repeat CD at 37-39 weeks appears to decrease the risk of stillbirth.Recommendation for repeat CD}
• ^{Respect of patient’s autonomy when she has been fully informed and expresses understanding of the issues.}
• ^{Recommended gestational age for repeat CD is 39-40 weeks.}
• ^{Avoid delivery before 39w unless medically indicated. CONCLUSION}

• ^{Synthesize a multitude of variables.}
• ^{Variation amongst exist.}
• ^{Additional research needed.}
• ^{Goal of thorough counselling and documentation should be a mutually endorsed decision that optimises maternal and neonatal outcomes.REFERENCES1.Centres for Disease Control and Prevention. FastStats: Inpatient Surgery. [www.cdc.gov/nchs/fastats/inpatient-surgery.htm].2.National Institute for Health and Care Excellence. Caesarean Section. CG132. London: NICE 2011 [http://www.nice.org.uk/guidance/CG132/chapter/Woman-centred-care].}

  ^{. Zhang J, Trodendle J, Reddy UM, Laughon SK, Branch DW, Burkman R et al. Contemporary caesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203: e1-10.}

  ^{4. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no.1: safe prevention of primary caesarean delivery. Obstet Gynecol 2014; 123: 693-711.}

  ^{Spong CY, Berghella V, Westrom KD, Mercer BM, Saade GR. Preventing the first caesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120:1181-93.}

  ^{6. American College of Obstetricians and Gynecologists. ACOG committee opinion no 559: Caesarean delivery on maternal request. Obstet Gynecol 2013; 121: 904-7.}

  ^{Ecker J. Elective caesarean delivery on maternal request. JAMA 2013; 309: 1930-6.}

  ^{8. Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM. Caesarean section for non medical reasons at term. Cochrane Database Syst Rev 2012; (3): CD004660.}

  ^{10.State-of-the Science NIH. Conference Statement on caesarean delivery on maternal request. NIH Consens State Sci Statements 2006; 23: 1-29.}