Im browsing the 2010 edition of Williams Obstetrics, and found the section on Informed Consent for births after a previous cesarean: No woman with a prior uterine incision should be forced to undergo a trial of labor. Instead, the risks and benefits of a trial of labor versus a repeat cesarean delivery should be discussed. The ultimate decision to attempt VBAC should be made by the informed woman in conjunction with her physician. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2007) recommend that the issues listed in Table 26-6 be addressed in arriving at that decision. And: TABLE 26-6. Recommended Counseling Points for Women With a Prior Cesarean Delivery • Advantages of a successful vaginal delivery, for example, shorter postpartum hospital stay; less painful, more rapid recovery; and others. • Contraindications to a trial of labor, for example, prior classical cesarean, previous uterine rupture, lack of resources to perform emergency cesarean delivery during labor, and others. • Relative contraindications, for example, two prior uterine surgeries with no previous vaginal delivery. • Risk of uterine rupture—generally less than 1 percent. • Increased risk of uterine rupture with multiple uterine surgeries, uterine tachysystole, attempts at cervical ripening or labor induction with oxytocin. • Uterine rupture has been associated with fetal death as well as severe neonatal neurological injury and may occur no matter what resources are available to manage it. From the American College of Obstetricians and Gynecologists and American Academy What do you think is missing from this information?
Posted on: Tue, 30 Dec 2014 14:25:00 +0000
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