- December 9, 2015
- Posted by: emobile
- Category: Trending Issues
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.
- 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.