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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Updated: Jul 30, 2025

External Cephalic Version: Is it an Effective and Safe Procedure?
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Delivery after a previous cesarean section reviewed.

Michael J Turner1

  • 1UCD Centre for Human Reproduction, Coombe Hospital, Dublin, Ireland.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|May 17, 2023
PubMed
Summary
This summary is machine-generated.

Vaginal birth after cesarean (VBAC) rates have fallen due to uterine rupture fears, but these risks are often overestimated. Prioritizing VBAC policies and improving resources for trial of labor after cesarean (TOLAC) is crucial for maternal health.

Keywords:
clinical risks and benefitshospital settingprevious cesarean sectionrepeat cesarean sectiontrial of labor after cesarean section (TOLAC)uterine rupturevaginal birth after cesarean section (VBAC)

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal Health
  • Surgical Outcomes

Background:

  • Cesarean section (CS) rates have significantly increased globally since the 20th century.
  • A primary driver of rising CS rates is the increase in repeat CS deliveries.
  • This is exacerbated by a decline in vaginal birth after cesarean (VBAC) rates, largely due to reduced trial of labor after cesarean (TOLAC) offerings.

Purpose of the Study:

  • To review international policies and trends concerning VBAC.
  • To assess the factors contributing to the decline in VBAC and TOLAC rates.
  • To highlight the need for a re-evaluation of current practices regarding delivery after CS.

Main Methods:

  • Systematic review of international VBAC policies.
  • Analysis of trends in VBAC and TOLAC rates worldwide.
  • Examination of reported risks associated with intrapartum uterine rupture.

Main Results:

  • The risk of intrapartum uterine rupture during TOLAC is low and potentially overestimated.
  • Many maternity hospitals lack adequate resources for safe TOLAC supervision.
  • Risk mitigation strategies for TOLAC, such as patient selection and clinical practices, may be underutilized.

Conclusions:

  • There is a need to re-evaluate global TOLAC policies due to the low risk of uterine rupture.
  • Improved resource allocation and utilization of risk mitigation strategies are essential for safe TOLAC.
  • A Global Consensus Development Conference on Delivery after CS should be considered to address rising CS rates and promote VBAC.