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VBAC

The document outlines the guidelines for vaginal birth after a previous cesarean (VBAC), detailing objectives such as indications, contraindications, and selection criteria for trial of labor after cesarean (TOLAC). It highlights that TOLAC has a success rate of 60-80% and discusses management strategies for labor and delivery, emphasizing the importance of monitoring and preparedness for emergency cesarean. Key contraindications include previous classical uterine incisions and inadequate resources for emergency interventions.

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10 views9 pages

VBAC

The document outlines the guidelines for vaginal birth after a previous cesarean (VBAC), detailing objectives such as indications, contraindications, and selection criteria for trial of labor after cesarean (TOLAC). It highlights that TOLAC has a success rate of 60-80% and discusses management strategies for labor and delivery, emphasizing the importance of monitoring and preparedness for emergency cesarean. Key contraindications include previous classical uterine incisions and inadequate resources for emergency interventions.

Uploaded by

Experiment Account
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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VAGINAL

BIRTH AFTER
PREVIOUS
CESAREAN
[VBAC] NISHA
18047.
INTRODUCTION
OBJECTIVES

• Indications of vaginal delivery after previous cesarean.


• Contraindication of trial of labour after caesarean [TOLAC].
• Selection criteria of case for TOLAC.
• TOLAC – Benefits and risk .
• Scheme 0f management of pregnancy with prior cesarean .
• Management of labour and delivery for TOLAC.
INTRODUCTION.

Trial of labor after cesarean is successful in 60-80 percent of cases ..


Maternal and perinatal mortality rates following trial of labor after cesarean
is the same when compared for elective repeat cesarean birth .
In suspected maturity it is better to wait for the pain to start and membrane
to rupture .
Vaginal delivery – if the previous section was done for some nonrecurrent
indication and the uterine scar is sound a vaginal delivery is to be planned
SELECTION CRITERIA ‘

• One or two lower segment transverse scar ‘


• Nonrecurring indication for prior cesarean section .
• Pelvis adequate for the fetus .
• Continued labour monitering possible .
• Availability of resources for emwrgency cesarean
section within 30 min of decidion .
• Informed consent of the women..
CONTRAINDICATIONS --

• Previous classical or inverted T – shaped uterine incision .


• Previous more than 2 lower segment caesarean section .
• Contracted pelvis or suspected CPD .
• Presence of other complications in pregnancy .
• Resources limited for emergency cesarean delivery or
patient refusal .
• History of prior uterine uterine rupture .
MANAGEMENT OF LABOUR AND
DELIVERY FOR TOLAC .

• Spontaneous onset of labor is desired . Induction of labour with prostaglandins increases the
risk of uterine scar rupture .
• Mechanical method [Foleys catherization ] is safe compared to PG .
• An intravenous line is commenced with ringer solution
• Blood group is sent for HB grouping and cross matching .
• Labour monitoring for scar dehiscence and electronically for fetal behaviour id done . Careful
serial clinical assessment is needed to ensure adequate cervicometric progress of labor .
• Analgesia – epidural is not contraindicated
• OXYTOCIN for aurmentation of labour may be used selectively and judiciously .
• Continious EFM is desirable .Presence of nonreassuring pattern ,severe variable
deceleration,prolonged deceleration or bradycardia warns uterine rupture

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