Vaginal Birth After Caesarean Section (VBAC): Possible Antenatal Predictors of Success and Role of Ultrasound

Trojano, Giuseppe; Olivieri, Claudiana; Carlucci, Nicola Antonio; Beck, Renata; Cicinelli, Ettore

doi:10.1007/978-3-030-57595-3_41

Cited by 3 publications

(9 citation statements)

References 33 publications

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“…VBAC rate decreases in obese women, however, appears unchanged in overweight women [33]. Weight fluctuation between pregnancy is correlated with decrease VBAC rates especially among women who had normal BMI in previous pregnancy [32].…”

Section: Body Mass Index < 30 Kg/m2mentioning

confidence: 94%

“…Prospective parturient(s) who are well motivated to have VBAC after careful selection and counselling is associated with a positive outcome and higher chances of successful VBAC. This has been found to be critical in patients that undergo VBAC when compared to patients that are unwilling to try a vaginal delivery [21,22,31,32].…”

Section: Maternal Willmentioning

confidence: 99%

“…There is conflicting evidence on the likelihood of uterine rupture on women with two previous lower segment caesarean sections. Women with two previous uncomplicated lower segment caesarean deliveries have VBAC success rates of 62-75% which is like single lower segment caesarean sections especially among women with previous vaginal delivery or previous successful VBAC [32]. However, it is reasonable to err on the side of caution and offer such women elective repeat caesarean section due to the conflicting data.…”

Section: Single Previous Lower Segment Caesarean Deliverymentioning

confidence: 99%

“…Non recurrent indications are associated with higher rates of successful VBAC. Sixty percent of women with cephalopelvic disproportion as the indication for previous caesarean delivery will achieve vaginal delivery, while 89% will achieve vaginal delivery for non-recurrent indications [32].…”

Section: Non Recurrent Indication For Csmentioning

confidence: 99%

“…Therefore, in a case to standardised caesarean section a single layer closure of the uterus is recommended [40]. The recommended optimal interval to guaranty uterine scar integrity and to reduce the risk of uterine is 6 and 18 months for interpregnancy and Interdelivery intervals respectively [27,32]. However, a recent retrospective study recommended an Interdelivery interval of 24 months to attempt VBAC [26].…”

Section: Adequate Inter Pregnancy or Inter Delivery Intervalmentioning

confidence: 99%

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Vaginal Birth after Caesarean (VBAC)

Nggada¹

2023

New Aspects in Cesarean Sections

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The rising rate of caesarean section has implications in the reproductive performance of a woman and increases the likelihood of complications during repeat operations, whether they are planned or performed on an emergency basis. A successful vaginal delivery after caesarean is associated with increased maternal satisfaction, reduced caesarean section rate, and appears to be cost effective. There is a need for careful selection of women that are willing to attempt vaginal birth after caesarean with a clear set of local protocols to increase overall success rate, reduce litigation and improve neonatal outcome. The benefits and risks of planned vaginal birth after caesarean and elective repeat caesarean section should be discussed in detail with the woman during antenatal care and reemphasized at admission to the labour ward. A decision to embark on VBAC should be free from coercion with full informed consent as the bedrock for such a decision. Facilities offering vaginal birth in women with prior caesarean delivery should be equipped with 24-hour standby emergency caesarean section capability. The intrapartum care should be carefully tailored to meet the woman’s need with support from the health care team. Every obstetrics unit should debrief women after delivery irrespective of the outcome and should conduct regular audits to improve the care of women with previous caesarean sections.

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Section: Body Mass Index < 30 Kg/m2mentioning

confidence: 94%

Section: Maternal Willmentioning

confidence: 99%

Section: Single Previous Lower Segment Caesarean Deliverymentioning

confidence: 99%

Section: Non Recurrent Indication For Csmentioning

confidence: 99%

Section: Adequate Inter Pregnancy or Inter Delivery Intervalmentioning

confidence: 99%

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Vaginal Birth after Caesarean (VBAC)

Nggada¹

2023

New Aspects in Cesarean Sections

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The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

et al. 2023

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To determine whether a trial of labor after two cesarean deliveries increases the risk of adverse maternal and neonatal outcomes and identify prognostic factors for TOLAC2 success.A retrospective cohort study was conducted The study group was comprised of women with two caesarean deliveries who attempted TOLAC (TOLAC2). Outcomes were compared to women undergoing TOLAC after one previous cesarean delivery (TOLAC1). The primary outcome was TOLAC success. Secondary outcomes included mode of delivery, uterine rupture, and combined adverse outcome(CAO) (uterine rupture, PPH, 5 minute Apgar < 7, pH < 7.1). Logistic regression was used for the multivariate analysis to identify prognostic factors for TOLAC2 success. 381 women who underwent TOLAC2 were compared to 3635 women who underwent TOLAC1. Women attempting TOLAC2 were less likely to achieve VBAC (80.8% and 92.5% OR 0.35 95% CI 0.26-0.47 p<0.001) and more likely to experience uterine rupture (0.8%Vs0.2% OR 4.1 95% CI 1.1-15.9 p=0.02) but not CAO (4.2% Vs 4.8% OR 0.88 95% CI 0.5-1.5 p=0.3). TOLAC2 women with no previous vaginal deliveries had a lower chance of VBAC and a higher risk of uterine rupture compared to TOLAC1 patientswomen without a prior vaginal delivery (45.2% vs 86.3% OR 0.13 95% CI 0.07-0.25 p<0.001) (2.3% Vs 0%) and TOLAC2 women with a prior vaginal delivery(45.2% Vs 85.3% OR 0.14 95% CI 0.1-0.3 p<0.0001) (2.4% Vs 0.6% OR 4.1 95% CI 0.4-46.3 p=0.3). Multivariate analysis revealed that a history of vaginal delivery is an independent predictor of TOLAC 2 success. Women attempting TOLAC2 are less likely to achieve VBAC and are at greater risk of uterine rupture compared to those attempting TOLAC1. Prior vaginal delivery seems to have a protective effect on TOLAC outcomes. This data should be used to counsel patientswomen and assist in decision-making when considering the mode of delivery in patientsw

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The Assessment of Cervical Length and Thickness of Cesarean Section Scar as Predictors for Preterm Labor in Patients with Previous Cesarean Section: A Prospective Cohort Study

Khalifa,

Abdel Basset,

Khairy

et al. 2024

Evidence Based Women's Health Journal

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Background: Cesarean sections (CS) have been increased all over the world. There is no doubt that CS scar from previous deliveries has an adverse effect on the function of the lower uterine segment (LUS) and the cervical canal length (CL). Objective: We examined the CL and thickness of lower uterine segment (LUS) by the antenatal ultrasound assessment to predict the occurrence of preterm birth (PTB). Materials and Methods: This is a prospective cohort study (including women with previous CS and non-scarred uterus) by ultrasonography assessment of the LUS and CL was performed to all women at the time of recruitment (18-25 weeks) and was repeated in scheduled follow-up visits tell reach term pregnancy. The study conducted between February 2021 and August 2022.The number of cases with PTB was our primary outcome. Results: Between the study (scarred uterus) n=140 and the control groups (non-scarred uterus) n=120 as regards age and body mass index (BMI) There were no significant differences. The study group showed a significant increase in PTB rate 26.1% (29/111) when compared to control group 11.8% (12/102) (p=0.008). The LUS in both groups had a significant thinning. However, the study group had more progressive thinning than the control group (5.25 ± 0.77 vs. 5.59 ± 0.80 mm, p= 0.001). According to CL, there was a progressive shortening of cervices in both groups. Conclusion:The assessment of CL and LUS thickness during antenatal care visits may improve neonatal outcomes due to its safety and feasibility.

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Vaginal Birth After Caesarean Section (VBAC): Possible Antenatal Predictors of Success and Role of Ultrasound

Cited by 3 publications

References 33 publications

Vaginal Birth after Caesarean (VBAC)

Vaginal Birth after Caesarean (VBAC)

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

The Assessment of Cervical Length and Thickness of Cesarean Section Scar as Predictors for Preterm Labor in Patients with Previous Cesarean Section: A Prospective Cohort Study

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