Vbac Research Paper

Discussion

Here I will discuss evidence surrounding the notion of “once a caesarean, always caesarean” and the current practise guideline. According to Uptodate, the 1960s research in support of “once a caesarean, always caesarean” has since been contradicted.

It was suggested by the National Institutes of Health and the American College of Obstetricians and Gynaecologists that labour may be trialled for a woman with history of one elective caesarean section with a low transverse uterine incision. This is given that there was no maternal complication (such as placenta praevia) that indicated the caesarean section. Woman who has had history of two prior caesarean sections (with low transverse uterine incisions) like MB may also be considered

However, about 20 to 40 percent of women who attempt VBAC required caesarean section as a result of failed trial of labour. Statically, about 0.2 to 1.5 percent of VBAC will be complicated by rupture of uterus. There’s some evidence for association between the type of uterine incision in previous caesarean section(s) and the risk of uterine rupture. Transverse uterine incision has the lowest risk of 0.2-1.5% as to vertical or T-shaped incisions that have 4-9% risk. Note direction of skin incision does not always reflect the direction of uterine incision. Both failure of labour and ruptured uterus require an emergency caesarean. Conversely, 60 to 80 percent of women who are considered candidates for a trial of labour after caesarean will have a successful vaginal birth. Fortunately, the risk of foetal death is very low with both VBAC and elective caesarean section but higher in

She has presented to ANC at 37+4 weeks with no new concerns although pt has expressed desire for VBAC. She has been advised about its contraindication and risks involved. She was disappointed but understands the safety issues and agreed to another elective caesarean section. Her antepartum course has been without any complication or abnormal investigation finding. The plan is to request to bring her elective caesarean section forward to 39 weeks. She is to be follow up at ANC in one