Predicting success and reducing the risks when attempting vaginal birth after cesarean

Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
Obstetrical & gynecological survey (Impact Factor: 2.36). 08/2008; 63(8):538-45. DOI: 10.1097/OGX.0b013e31817f1505
Source: PubMed

ABSTRACT The goal of this manuscript is to review the contemporary evidence on issues pertinent to improving the safety profile of vaginal birth after cesarean (VBAC) attempts. Patients attempting VBAC have success rates of 60%-80%, and no reliable method of predicting VBAC failure for individual patients exists. The rate of uterine rupture in all patients ranges from 0.7% to 0.98%, but the rate of uterine rupture decreases in patients with a prior vaginal delivery. In fact, in patients with a prior vaginal delivery, VBAC appears to be safer from the maternal standpoint than repeat cesarean. Inevitably, the obstetrician today will encounter the situation of deciding whether or not to induce a patient with a uterine scar, and particular attention is paid to the success and risks of inducing labor in this patient population. Induction of labor is associated with a slightly lower successful vaginal delivery rate, although the rate remains above 50% in virtually all patient populations. The rate of uterine rupture increases slightly, but still remains around 2%-3%. Although misoprostol use is discouraged due to its association with increased risks of uterine rupture, transcervical catheters, oxytocin, and amniotomy may be used to induce labor in women attempting VBAC.

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    ABSTRACT: Vaginal birth after caesarean section is the delivery of a baby through the vagina after a previous cesarean delivery. For this to be conducted safely and responsibly emergency obstetric care must be available. To study the different modes of delivery in Dhulikhel Hospital (DH), evaluate the frequency of attempted and successful vaginal birth after caesarean section and, in the VBAC group, to identify those factors that may influence outcome and safety. The study was a retrospective study of all women who were delivered via different routes and the subgroup who underwent attempted vaginal birth after caesarean section in DH from January 2007 to December 2009. In this study factors associated with the successful VBAC were also analyzed. During the study period a total of 4215 deliveries conducted in DH and a total of 890 lower segment caesarean sections (21.1% of all deliveries) were performed. Of the 890 caesareans performed, 743 were primary and 147 were repeat (69 were repeat elective and 78 were repeat emergency). In this period an additional 33 women with previous lower segment caesarean sections had a successful vaginal delivery. Hence 18.3% (33/180) vaginal birth after caesarean sections was conducted successfully among women with previous caesarean). The results of this study indicate that vaginal birth after caesarean section is a clear feature of obstetric practice in DH. This is possible because of the vigilance in managing these women and the availability in this hospital setting of resources for immediate cesarean section.
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    ABSTRACT: A review of the literature and analysis of the National Inpatient Sample Database was performed to describe the trends in vaginal birth after cesarean availability in the United States and the factors associated with changing use. Vaginal birth after cesarean increased after the first National Institutes of Health Consensus Conference on Cesarean Childbirth in 1981. It increased from 3% to a maximum rate of 28.3% in 1996. Despite studies reporting stable success rates of approximately 70% and low complication rates (<1%), concerns about patient safety and physician liability have led to more restrictive policies and a decrease in vaginal birth after cesarean use. The current rate is approximately 8.5%, and decreased rates have been noted for all age and ethnic groups. There is decreased use of vaginal birth after cesarean as the result of concerns about patient safety and physician liability, which has resulted in decreased availability.
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