Hi,
This is my 2nd pregnancy due 26th of July and Im finding it hard to except the decision made by my OBGYN that I will need to have an elective c-section. With my first born, May 22nd 99 I had a C after 18hrs of labour but Im not entirely sure why, I have a slite biconate uterus which after 10wks gestation could'nt be seen on u/s and I am only 5ft tall (my first weighed 6pnd 14oz). I did'nt dialate past 1cm so they were going to induce but they could'nt get the epedural in as my spine is to close together so I had a C under general.I asked my OBGYN If I could have a trial labour but he said It would be in my best interests to have an elective C as It would be a waste of my energy and that due to my biconate uterus the contractions will most likely be inafective. Do you have any thought on the subject? Apart from the C decision I realy like my OB so I would prefer not to change but I just want to be sure that a C is the best route for me.
Tiff
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Dr David
Moderator posted 19 March 2001 07:08 AM
Tiff
It is difficult to give specific advice about a particular situation but I would highlight the following points:
I know of no study that shows a correlation between height and successful VBAC.
It sounds like your labour started by itself last time but that Syntocinon (Pitocin in N.America) was going to be used (this is "medically&endash;speaking" augmentation, not induction), but couldn't because of inadequate analgesia. Your Caesar could be labelled then for "lack of progress". Chance of vaginal birth next time with this indication for the first caesar are around 67%. That is, two out of three women who had a first caesar for lack of progress can expect to birth vaginally next time if they try. (Flamm et al. Obstet Gynecol 1994;83:927-32)
The issue of bicornuate uterus could be further discussed with your doctor in the light of a Canadian study by Ravasia (AmJOG 1999;814:877-81)
Although numbers were small (bicornuate uterus and other mullerian duct anomalies are fairly rare), there did seem to be a significantly increased risk of uterine rupture (2 out of 25 or 8%)in the group of women with mullerian duct anomalies who attempted VBAC, when compared with those women with normal uterus who attempted VBAC. Some reasons for immediate urgent Caesar in labour (cord prolapse and severe baby heart rate changes) were also more common. The overall VBAC rate, though, was 80% suggesting that uterus contractions can be adequate.
It would be important to review the whole study with your doctor, however, as often important details are not included in the abstract (or summary). For example, both of the women who had mullerian anomalies and ruptured uterus were induced with prostaglandin gel.
Dr.David
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
consult your health care provider for individual
advice.