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Guidelines for vaginal birth after previous Caesarean birth
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|June 10, 2005
Summary
Women with one prior low-segment Caesarean section should be offered a trial of labour (TOL) with informed consent, emphasizing risks and benefits. Continuous monitoring and hospital preparedness are crucial for safe vaginal birth after Caesarean (VBAC).
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Evidence-based guidelines are essential for managing trial of labour (TOL) after Caesarean section.
- Understanding fetal and maternal risks associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section is critical.
Framework:
- Guidelines developed from MEDLINE search (1995-2004) using keywords 'vaginal birth after Caesarean section'.
- Evidence quality assessed using the Canadian Task Force on the Periodic Health Exam criteria.
Implementation:
- Offer TOL to women with one prior low-segment Caesarean section, ensuring informed consent and documentation.
- Continuous electronic monitoring during TOL is recommended.
- Hospitals must have policies for timely Caesarean delivery, with clear protocols for urgent laparotomy (approx. 30 minutes).
Implications:
- Oxytocin augmentation is permissible; however, medical induction with oxytocin or prostaglandin E2 requires careful counselling due to increased uterine rupture risk.
- Prostaglandin E1 is contraindicated for TOL. Foley catheter use for cervical ripening is safe.
- TOL is viable for multiple gestations, diabetes, suspected macrosomia, and postdates, but counselling on uterine rupture risk is needed for short interpregnancy intervals (18-24 months).
- Determining the type of uterine incision from previous Caesarean reports is vital for offering TOL.