What are the chances of giving birth without having another c-section?
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Dr David
Moderator posted 24 January 2001 07:55 PM
Suzy
There are several large reported series of VBA2C.
Phelan reports 1088 women who had had two previous cesareans; of these, 501 (46%) underwent a trial of labor and 346 (69%) delivered vaginally. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2911420&dopt=Abstract1.
More recently, Caughey reports 62% VBA2C in 134 women with 2 previous caesars. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10521745&dopt=Abstract
The Canadian Society of O&G's suggests "Labour and vaginal delivery in women with more than one previous transverse low segment incision is an acceptable option, although there are less data available. Each situation should be carefully assessed. The incidence of scar dehiscence (less than 4%) is higher than that associated with one previous section."
http://www.sogc.medical.org/SOGCnet/sogc_docs/common/guide/pdfs/ps68.pdf
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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Dr David's 2nd Response -
Moderator posted 26 January 2001 12:24 PM
Suzy
Asakura reports experience over 5 years in a major US hospital. 302 of 435 (69%) women with more than one Caesar attempted VBAC, along with 1110 of 1206 (92%) with one previous Caesar.
Scar separation: For those with more than 2 caesars, uterine scar separation was uncommon (dehiscence 1.4%, rupture 0.7%) and was independent of whether VBAC was attempted (dehiscence 1.0%, rupture 1.0%). Not statistically significant difference from those with only one previous Caesar (dehiscence 0.7%, rupture 0.7%). There were no baby deaths due to uterine scar separation in the 1677 newborns (must have been some twins). Two babies were damaged by asphyxia directly related to uterine rupture, but both were thought to be preventable - one VBAC had rupture after 4 hour second stage, and one VBA2C had rupture during 40 minute period when unattended and when the pattern of CTG monitoring suggested rupture. Hysterectomy was needed more often in those with more than one caesar (4/435 [0.9%] vs 1/1206 [0.1%]),because of increased risk of placenta accreta, but was not more likely if labour attempted.
VBAC rates
Summary of the literature up till 1995, more than one previous Caesar and labour attempted, VBAC rate 65%.
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.