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Created on : 01 Feb 2006
Modified on : 01 Dec 2007

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Bibliographical entry (without author) :

VBAC: reducing medical and legal risks. ClinOG, 44, p.622

Author(s) :

Flamm

Year of publication :

2001

URL(s) :

Résumé (français)  :

Abstract (English)  :

Summary, One lesson is that when a poor outcome occurs, even if you have made no technical errors and even if patient rapport is wonderful, you may still be sued and you may lose. It must be emphasized that once a uterus is scarred, the risk of any and all subsequent pregnancies is increased and selecting one mode of birth instead of the other cannot eliminate this risk. Things to watch out for: 1. Previous classical or T-shaped uterine incisions. Estimates for low vertical ruptures range 1-5% and for classical 5-10%. There is no data on a T incision but generally thought to be contraindicated. 2. Unknown scar, probably OK, one of the largest studies showed a 1% rupture rate with 90% unknown scar. 3. Placenta previa/accreta, this is a major potential risk for life threatening placenta previa accreta. The risk may be as high as 30% with Hx of PCS. 4. Misoprostol, avoid, also avoid outpatient cervical ripening. 5. More than one PCS: exercise caution, risk of rupture is 1.8%. 6. Oxytocin: exercise caution, oxytocin can cause rupture in both scarred and unscarred uteri. 7. Clinical signs of uterine rupture, none are "classic", certainly heavy vaginal bleeding is always of concern, dramatic loss of station. 8. Fetal Monitor: Prolonged deceleration of FHT to 60-70 lasting more than a few minutes requires rapid intervention, as do variable decelerations that are severe and do not respond to nursing intervention. 9. Informed Consent: Must find a middle ground between over informing or a "scorched earth" process versus not informing the patient enough. Strongly suggests a formal consent form balancing the risks of repeat CS and the risks of VBAC. 10. Response Time: There is no "17 minute rule" however since uterine rupture is the main risk of VBAC, it would be prudent for physician to remain in or very near the hospital while a patient is attempting VBAC. Practicing crash CS drills may also help as would having a minimal emergency CS tray always available to eliminate the time of counting instruments before the baby is out. If rapid response is not possible, patients should have a repeat CS or be referred to a center where physicians and facilities are immediately available.

Sumário (português)  :

Resumen (español)  :

Comments :

Fiche importée de http://www.worldserver.com/turk/birthing/rrvbac2000-4.html avec l’aide de Ken Turkowski, septembre 2005

Argument (français) :

Argument (English):

Argumento (português):

Argumento (español):

Keywords :

➡ vaginal birth after caesarean ; c-section/caesarean ; misoprostol (Cytotec) ; induction of labor

Author of this record :

Ken Turkowski — 01 Feb 2006
➡ latest update : Bernard Bel — 01 Dec 2007