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.



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