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Vaginal birth after cesarean

M J McMahon1

  • 1University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology 27599-7570, USA.

Clinical Obstetrics and Gynecology
|July 1, 1998
PubMed
Summary
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For most women, attempting vaginal birth after cesarean delivery (VBAC) is encouraged. However, careful counseling and management are crucial due to potential risks like uterine rupture, especially with unknown or classical uterine incisions.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Vaginal birth after cesarean delivery (VBAC) is a significant shift in obstetric practice.
  • Decisions involve trial of labor (TOL) versus elective repeat cesarean delivery (ERCD).

Purpose of the Study:

  • To review the indications, contraindications, and management of VBAC.
  • To highlight the risks and benefits of TOL versus ERCD.

Main Methods:

  • Review of existing literature on VBAC.
  • Analysis of contraindications, including uterine incision type.
  • Discussion of management strategies for specific scenarios (e.g., breech, multiple gestation).

Main Results:

  • VBAC should be encouraged for most women with prior cesarean.

Related Experiment Videos

  • Classical uterine incisions are an absolute contraindication to TOL.
  • Evidence for TOL in certain situations (unknown incision, low vertical scar, breech, multiple gestation, induction) is limited, requiring individualized counseling and management.
  • Uterine rupture is the most severe complication; prompt intervention is vital.
  • Women unsuccessful in TOL face higher risks.

    • Conclusions:

    • No reliable method currently exists to predict successful VBAC or identify women best suited for ERCD.
    • Management of labor after cesarean requires careful consideration and individualized counseling.
    • Further research is needed to develop predictive methods for TOL success and safety.