My wife went 11 days over with our first child and was induced with gel. She had an 'early' epidural, dilated to 10 cm in about 10 hours or so, but the baby was OP, failed to engage and was never more than 2/5ths above synciput(?). Inco-ordinate contractions were treated with a Pitocin drip, but despite some early 'forming', there was no real progresion. An emergency C-Section was done as late decelerations were getting longer and lower.
Basically, I guess my question is if at term for this second pregnancy, she is still 'high', with no engagement and an unripe cervix etc. Is it likely that a VBAC will work? She is anxious not to repeat the last birth experience!
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Dr David
Moderator posted 24 January 2001 07:32 PM
Peter and partner
The diameter of the head that presents when a baby is OP is much larger than if the baby is OA, and this is reason enough for the head to not descend in second stage.
Some people suspect that induction may increase the risk of OP, and that epidural analgesia may interfere with spontaneous rotation of the head by relaxing the pelvic floor muscles. I don't have published data on this. Without specifically looking at OP positions, the cochrane study on post-term pregnancy suggested that induction did not increase the risk of caesar. http://www.cochrane.de/cochrane/revabstr/ab000170.htm
You may mean that the head stayed 2/5 above the pelvic brim. This amount of head still being felt abdominally means that assisted vaginal birth is not considered safe, especially in the presence of a non-reassuring CTG pattern.
"Is it likely that a VBAC will work?"
In Phelan's early study of VBAC 77% of women whose previous Caesar was for CPD/failure to progress had vaginal birth next time. (AMJOG 1985;151:297-304)
A recent report (see Pubmed reference below) of 103 women who laboured next time after a Caesar where full dilation had been reached but the head didn't descend, described 80% vaginal birth rate. Most had spontaneous labour in the pregnancy, and if possible this would usually give the best chance of vaginal birth. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9800930&dopt=Abstract
Consider reading about Optimum fetal positioning. See reference to this on the VBAC discussion forum.
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.
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