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Define VBAC
A vaginal delivery after C-section
Define TOLAC
Trial of labour after C-section
What are the maternal benefits of VBAC?(5)
Avoids risk of surgery
Decreases maternal haemorrhage
Faster recovery & hospital stay
Improved bonding and breastfeeding
Higher success for future VBAC
What are the fetal benefits of VBAC?(2)
VBAC have a lower risk of initial respiratory morbidity (TTOTN)
Lower risk of perinatal deaths
What are the maternal prerequisites of a VBAC? (4)
BMI <40
Interval pregnancy +18 months
1 previous C-section (no classical / T shaped scar)
Absence of obstetric indications for C/S
What are the fetal prerequisites of a VBAC? (3)
Estimated fetal weight <3500 g
Singleton
Cephalic presentation
What is the predicting VBAC success rate?
60-88%
What are the facility & resource requirements for VBAC?(3)
Hospital equipped with 24-hour emergency theatre facilities
Continuous intrapartum monitoring capabilities
Staff ready to perform an immediate C-section and advanced neonatal resuscitation
Which IV solutions should be administered during intrapartum care? (2)
IV drip NaCl 0.9% or
Ringer’s lactate at 80-120 mL/ hour
What is the intrapartum care checklist for a VBAC? (5)
CTG monitoring (soon as uterine contractions start)
IV access
Blood should be ready
Urinary catheter
Pain relief epidural analgesia
What are the primary warning signs of a uterine rupture? (5)
Abnormal fetal heart rate (most consistent finding)
Abdominal pain > severe and persistent between contractions / acute tenderness
Sudden cessation of uterine contractions
Bleeding
Maternal tachycardia/ hypotension
What is the classical triad of a complete uterine rupture?
Pain
Vaginal bleeding
FHR abnormalities
What are the immediate resuscitations for a uterine rupture?(3)
Secure access & fluids (IV fluids)
Bloods > U&E, FBC, PTT
Blood products > 4 red cell concentrations, 4 fresh frozen plasma, 1 adult dose of platelets