VAGINAL DELIVERY AFTER CESAREAN

Vaginal Delivery after Cesarean

Table of Contents

Introduction3

Discussion3

Signs and Symptoms/Clinical Presentation5

Risks of VBAC6

Conclusion7

Vaginal Delivery after Cesarean

Introduction

Vaginal Birth after a Caesarean section is the true meaning of the acronym VBAC. The same means giving birth to a baby by vaginal delivery after having had one or more cesareans. Over 80% of women may opt for a VBAC. VBAC is safer than undergo repeated cesarean section, and if he had undergone a previous caesarean section, it does not imply an increase in risks for a pregnant woman or her baby. Every woman has a different reason for wanting a vaginal birth after having had in the past to a cesarean. For many women, the justification may be medical, while other women feel an emotional need to give birth to her baby by vaginal delivery. On the other hand, there could be financial or related to the recovery period.

Discussion

The decision to undergo vaginal birth after cesarean delivery (VBAC) is based on evaluating the predictors of a successful trial of labor and the risk of complications, antenatal, in labor, and in delivery, and in future pregnancies, against the patient's preference. The American College of Obstetricians and Gynecologists (ACOG) advises against VBAC for women who have had a classical hysterectomy (i.e., a vertical incision that extends above the insertion of the round ligaments), extensive transfundal uterine surgery, and previous uterine rupture, medical or obstetric complication that precludes vaginal delivery, or two prior uterine scars and no vaginal deliveries (Landon, 2008).

Although there have not been any large, randomized, controlled trials regarding the predictors of a successful trial of labor, retrospective cohort and case-control studies indicate that the following are the significant variables:

•Obstetric history. Patients who have had a prior vaginal birth (86.6% chance of successful VBAC), prior VBAC, and no nonrecurring indication for cesarean delivery (e.g., cephalopelvic disproportion [i.e., pelvis too narrow to permit passing of the fetal head], dystocia [i.e., failed second stage of labor], placenta previa [i.e., implantation of the placenta over or near the internal os of the cervix], active genital herpes, fetal malposition [e.g., fetus in transverse or breech position], or multiple births) has a higher chance of successful VBAC.

•Preterm delivery increases the chance of a successful VBAC

•Maternal characteristics. Women who are aged > 40 years, Latina or African-American, shorter and/or obese, or who have diabetes mellitus (preconceptional or gestational), preeclampsia (i.e., pregnancy-induced hypertension in the mother), or placental abruption (i.e., placental separation from the uterine wall) are less likely to have a successful VBAC.

Fetal characteristics that are associated with increased risk for cesarean delivery

Birth weight > 4,000 g is associated with an almost 4-fold higher risk of cesarean delivery

Gestational age = 41 weeks

Induction of labor increases the risk of cesarean delivery 2- to 3-fold

The risk of uterine rupture is a significant concern when evaluating a patient for a trial of labor following cesarean delivery. The risk is increased for women who have had a classical hysterectomy incision, two or more cesarean deliveries, single-layer uterine closure, and use of prostaglandins to ...