Download Citation on ResearchGate | On Jan 1, , D.H. Chestnut and others published ACOG Practice Bulletin No. Vaginal birth after previous. ACOG Updates Recommendations on Vaginal Birth After Previous of Obstetricians and Gynecologists. ACOG practice bulletin no. (Replaces Practice Bulletin Number , August ). Committee on Practice Bulletins-Obstetrics. This Practice Bulletin was developed by the American.

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The chances of achieving VBAC are similar between these groups of women.

ACOG Practice Bulletin No. Vaginal Birth After Cesarean Delivery

ptactice Although a trial of labor after previous cesarean delivery TOLAC is appropriate in select women, several factors increase the likelihood of complications. Understanding the Dangers of Cesarean Birth: Therefore, this agent should not be used for third trimester cervical ripening or labor induction in women who have had a previous cesarean delivery or major uterine surgery.

However, although TOLAC is appropriate for afog women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor ie, VBAC and elective repeat cesarean delivery 4—6. One large study found an increased risk of uterine rupture, whereas a second study found no increased risk, and a third found no increased risk when prostaglandins were used #1155 with no subsequent oxytocin [Pitocin].

By not making any changes in this recommendation, hospitals that cannot meet this requirement are not likely to begin offering medical care for VBAC.

Increased probability of success. More practiec Pubmed Citation Related Articles. Factors Associated with Successful Trial of Labor After Previous Cesarean Delivery Increased probability of success Previous vaginal birth Spontaneous labor Decreased probability of success Gestational age greater than 40 weeks Increased prcatice age Increased neonatal birth weight Maternal obesity Nonwhite ethnicity Preeclampsia Recurrent indication for cesarean delivery Short interpregnancy interval Adapted with permission from American College of Obstetricians and Gynecologists.


Solving the vaginal birth after cesarean dilemma [editorial]. Why the Discrimination in U.

Decisions about TOLAC should take into account the possibility of future pregnancies, because delivery decisions made in the first pregnancy after a cesarean delivery typically affect plans in subsequent pregnancies.

Women with twin gestations who attempt VBAC have similar outcomes to women with singleton gestations. Since the mids, however, medicolegal issues and concerns about the risk of uterine rupture have contributed to a reversal in this trend. No significant association was noted between unknown incision types and rates of uterine rupture. See My Options close Already a member or subscriber?

There is limited evidence blletin the risk of uterine rupture is greater in women who have not had a previous vaginal delivery and who are attempting TOLAC with a macrosomic fetus. Although labor can be induced for maternal or fetal indications in women attempting TOLAC, physicians should counsel the patient that it increases risk of uterine rupture and decreases the possibility of successful VBAC. Choose a single article, issue, or full-access subscription.

It is unclear whether the risk of uterine rupture is lower in women attempting TOLAC who have had only one previous cesarean delivery compared with those who have had more. Vaginal birth after previous cesarean delivery. Making Informed Decisions By: Women attempting TOLAC with a macrosomic fetus greater than 4, to 4, g [8 lb, 13 oz to 9 lb, 15 oz] have a lower likelihood of successful VBAC than those who have a nonmacrosomic fetus.

Wcog andrates of vaginal birth after previous cesarean delivery VBAC increased steadily. Vaginal birth after cesarean: The outcome of TOLAC that most significantly increases the risk of maternal and neonatal #115 is uterine rupture or dehiscence. No advertisements are accepted. Although previous and predicted birth weights should be considered when making delivery decisions, suspected macrosomia alone is not a contraindication for TOLAC. Jan 15, Issue. This method provides women who desire a vaginal delivery the possibility of achieving that goal—a vaginal birth after cesarean delivery VBAC.


Many hospitals no longer allow VBAC because they are not able to provide immediate access to surgeons and anesthesiologists, and some insurance carriers prohibit physicians from performing the procedure.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Individual demographic and obstetric factors that affect a woman’s probability of successful TOLAC are listed in Table 1.

Women who have had a previous cesarean delivery because of dystocia also have a lower likelihood of VBAC if the weight of the current fetus is greater than that of the index pregnancy. It is important to note, however, that these data are based on actual—not predicted—birth weight, thus limiting their applicability when making delivery decisions antenatally.

ACOG Updates Recommendations on Vaginal Birth After Previous Cesarean Delivery

VBAC is associated with decreased maternal morbidity and a decreased risk of complications with future pregnancies and births.

ACOG practice bulletin no. Get immediate access, anytime, anywhere. This website provides childbearing women and maternity care professionals evidence-based information, resources, and support for VBAC and cesarean prevention. Studies of the effects of prostaglandins on uterine rupture in women who have had a previous cesarean delivery have had inconsistent results. The safety of VBAC has been questioned in women who had a previous cesarean delivery with an unknown incision type.

Already a member or subscriber? The information and the links provided on the VBAC.