December 2004 · Vol. 16, No. 12VBAC: When is it safe?
When do risks outweigh benefits, in light of ACOG’s newly cautious advisory? What conditions call for extra concern?
|
Fast Track
Women who at first appear eligible may harbor conditions that call for special vigilance.
Personally review the prior operative note before attempting a trial of labor.
The less time between deliveries, the more likely is uterine rupture.
|
|
Lynn
L.
Simpson,
MDAssociate Professor, Department of Obstetrics and Gynecology,
Columbia University Medical Center,
New York City
|
KEY POINTS
-
Selection criteria useful for identifying candidates for VBAC include: a limit of 1 prior low-transverse cesarean, clinically adequate pelvis, no other uterine scars or previous rupture, and no contraindications.
-
Offer VBAC only if obstetric care and anesthesiology are available throughout active labor, in case emergency cesarean is necessary.
-
Single-layer uterine closure may increase the risk of rupture during subsequent labors.
-
Epidural anesthesia is safe for women undergoing a trial of labor.
|
A woman’s first cesarean may be more fateful than ever, because 1 low-transverse cesarean delivery is the new limit for a trial of labor in subsequent pregnancies, advises a 2004 practice bulletin from the American College of Obstetricians and Gynecologists (ACOG).1 The previous bulletin on vaginal birth after cesarean (VBAC) recommended a limit of 2.
The new bulletin reaffirms the previous recommendation that obstetric and anesthesia personnel be immediately available throughout active labor, in case emergency cesarean is necessary.
|
