This document discusses management of women with previous caesarean sections. It notes that the caesarean delivery rate is around 25% and risks of placenta previa and accreta increase with additional c-sections. For subsequent pregnancies, most women with a single prior lower segment c-section are suitable for a planned VBAC, though risks include uterine rupture. ERCS avoids rupture risk but has longer recovery and increases risks of complications in future pregnancies. Close monitoring is needed during both planned VBAC and ERCS.
This document discusses management of women with previous caesarean sections. It notes that the caesarean delivery rate is around 25% and risks of placenta previa and accreta increase with additional c-sections. For subsequent pregnancies, most women with a single prior lower segment c-section are suitable for a planned VBAC, though risks include uterine rupture. ERCS avoids rupture risk but has longer recovery and increases risks of complications in future pregnancies. Close monitoring is needed during both planned VBAC and ERCS.
This document discusses management of women with previous caesarean sections. It notes that the caesarean delivery rate is around 25% and risks of placenta previa and accreta increase with additional c-sections. For subsequent pregnancies, most women with a single prior lower segment c-section are suitable for a planned VBAC, though risks include uterine rupture. ERCS avoids rupture risk but has longer recovery and increases risks of complications in future pregnancies. Close monitoring is needed during both planned VBAC and ERCS.
This document discusses management of women with previous caesarean sections. It notes that the caesarean delivery rate is around 25% and risks of placenta previa and accreta increase with additional c-sections. For subsequent pregnancies, most women with a single prior lower segment c-section are suitable for a planned VBAC, though risks include uterine rupture. ERCS avoids rupture risk but has longer recovery and increases risks of complications in future pregnancies. Close monitoring is needed during both planned VBAC and ERCS.
• Majority were emergency LSCS (15%) AND elective LSCS (10%) • Management of women with a scarred uterus in subsequent pregnancies is one of the most common reasons for hospital referral in multigravida • Counselling women for and managing birth after caesarean delivery are important issues RISKS OF PREVIOUS UTERINE INCISION TO CURRENT PREGNANCY
• Placenta previa • Placenta accreta • Incidence of both condition will increase with the no. of Caesarean section. MANAGEMENT OF WOMEN WITH PREVIOUS CAESAREAN SECTION
• Start counselling for mode of delivery soon after the woman’s mid trimester ultrasound (28 Weeks) • VBAC versus ERCS checklist and shared decision making and documentation (36 weeks in Malaysia) SUITABILITY FOR PLANNED VBAC
• majority of women with:
• a singleton pregnancy of cephalic presentation • who have had a single previous lower segment caesarean delivery, with or without a history of previous vaginal birth SUITABILITY FOR PLANNED VBAC
Contraindications to VBAC • previous uterine rupture • classical caesarean scar • women who have other absolute contraindications to vaginal birth (eg. P Previa) • More than one previous uterine incision (in Malaysia) *In women with complicated uterine scars, caution should be exercised and decisions should be made on a case-by-case basis by a senior obstetrician with access to the details of previous surgery. SUITABILITY FOR PLANNED VBAC
The factors associated with an increased risk of uterine rupture in women
undergoing VBAC • Short inter-delivery interval (less than 2 years since last delivery) • Post-date pregnancy • Maternal age of 40 years or more • Obesity (BMI>30) • Lower pre-labour Bishop score • Macrosomia • Decreased ultrasonographic lower segment myometrial thickness (<2 mm) RISKS AND BENEFITS OF VB AC Vs ERCS
BENEFITS VBAC ERCS • 72–75% chance of successful • Able to plan a known VBAC delivery date in select • If successful, shorter hospital patients stay and recovery • Virtually avoids the risk of • Increases likelihood of future uterine rupture vaginal birth • Reduces the risk of pelvic • Virtually avoids the risk of organ prolapse and urinary surgery and its anaesthesia incontinence • REDUCED risk of transient • Option for sterilisation if respiratory morbidity of 2– fertility is no longer 3% desired RISKS AND BENEFITS OF VB AC Vs ERCS
RISKS VBAC ERCS • Scar rupture (0.5%) • Long recovery • Preneal trauma and/or Anal • Risk of surgery and its sphincter injury anaesthesia • Antepartum stillbirth beyond • Future pregnancies – 39+0 weeks while awaiting • likely to require caesarean spontaneous labour(similar to delivery nulliparous women) • increased risk of placenta • Hypoxic ischaemic praevia/accreta encephalopathy (HIE) (0.08%) • INCREASED risk of transient • Delivery-related perinatal respiratory morbidity (4–6%) death(similar to nulliparous • INCREASED risk of maternal women) death I NT R A PA RT UM M A N AGE M ENT O F P LA NNE D V B AC
• Planned VBAC should be conducted:
• Suitably staffed & Well-equipped hospital • Continuous intrapartum care and monitoring (Continuous CTG Monitoring) • Resources available for immediate caesarean delivery and • Advanced neonatal resuscitation I NT R A PA RT UM M A N AGE M ENT O F P LA NNE D V B AC
Women in established VBAC labour should receive:
• supportive one-to-one care • intravenous access with full blood count and blood group and save • continuous electronic fetal monitoring • regular monitoring of maternal symptoms and signs • regular (no less than 4-hourly) assessment of their cervicometric (Partogram) progress in labour. I NT R A PA RT UM M A N AGE M ENT O F P LA NNE D V B AC
The clinical features associated with uterine scar rupture include:
• Abnormal CTG • Severe abdominal pain, especially if persisting between contractions • Abnormal vaginal bleeding • Acute onset scar tenderness • Haematuria • Cessation of previously efficient uterine activity • Maternal tachycardia, hypotension, fainting or shock • Loss of station of the presenting part I NT R A PA RT UM M A N AGE M ENT O F P LA NNE D V B AC
Scar Dehiscence/ Rupture
• Early diagnosis of uterine scar dehiscence or rupture • Resuscitation • Expeditious laparotomy • Repair Ut Scar if it is repairable otherwise Hysterectomy • Neonatal resuscitation * Once scar dehiscence/ rupture happened à no more VBAC trial IOL FOR PREVIOUS UTERINE SC AR
• increased risk of uterine rupture (2 – 3 times)
• increased risk of caesarean delivery (0.5 time) • A senior obstetrician should discuss the following with the woman: • Indication of IOL • Proposed method of induction • *IOL with mechanical methods (amniotomy or Foley catheter) àlower risk of scar rupture compared with induction using prostaglandins. PLANNING AND CONDUCTING ERCS
• ERCS delivery should be conducted at or after 39+0 weeks of gestation***
• Antibiotics prophylaxis before skin incision • Thromboprophylaxis if there is risk factor • Early recognition of placenta praevia • Multidisciplinary approach and informed consent in cases of placenta praevia and previous caesarean delivery (coz of higher chance of placenta accreta) *** In cases of ERCS before 39 weeks à Corticosteroid to reduce transient tachypnea of newborn
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Gynecology: Three Minimally Invasive Procedures You Need to Know About For: Permanent Birth Control, Heavy Menstrual Periods, Accidental Loss of Urine Plus: Modern Hormone Therapy for the Post Menopausal Women
Instant Download International and Comparative Employment Relations National Regulation Global Changes Greg J Bamber & Russell D Lansbury & Nick Wailes & Chris F Wright PDF All Chapter
