LETTERS

Scoring patients for VBAC

In “VBAC: Safer than you think” [August], Ellen Mozurkewich, MD, recommends carefully selecting patients for vaginal delivery after cesarean (VBAC). However, she does not offer clear guidelines for such a selection process. Here at Elmhurst Hospital Center-Mt. Sinai affiliation, we utilize a scoring system to identify candidates at low, medium, and high risk for VBAC (Table 1). While patients who score from 16 to 20 points are considered low-risk and, therefore, good candidates for VBAC, patients who score 0 to 5 points are considered high-risk and should never be offered a trial of labor. Medium-risk patients, scoring from 6 to 15 points, require individualized consideration with extensive counseling.

—E. HAKIM-ELAHI, MD
CHIEF OF WOMEN’S HEALTH SERVICES
ELMHURST HOSPITAL CENTER
ELMHURST, NY