Trial Of Labor & Vbac

The overall risk of Uterine Rupture in TOLAC is small, 0.5 - 0.9% however it is associated with such high morbidity and mortality for the fetus and the mother it deserves special consideration. Factors that increase the risk of rupture were previous classical incision, macrosomia, gestation beyond 40 wks and induction and augmentation of labor. The studies with a largest number of patients are retrospective studies that looked at discharge diagnosis to gather data and didn’t account for hospital course, confounding factors and the extent to which each risk factor was present.

The overall probability of VBAC in TOLAC is 60-80% but on an individual basis the success rate depends on demographic and obstetric charactorisitics. For example a women who has a C-section for breech presentation would have a good chance of achieving VBAC whereas a woman who a c-section because of arrest of labor is less likely to succeed.

Factors that increase the likelihood of successful VBAC are:
- Prior Vaginal deliveries
- Spontaneous Labor
Factors that decrease the likelihood of successful VBAC are:
- Increased maternal age
- Non-White ethnicity
- Gestational age greater than 40 weeks
- Maternal obesity
- Preeclampsia
- Short interpregnancy interval
- Increased neonatal birth weight
- Recurrent indication for initial cesarean delivery (like labor dystocia)

VBAC (Vaginal Birth After Cesarean) is a preferred option for many women who have previously undergone a cesarean section. It offers several benefits over a repeat cesarean, including reduced rates of hemorrhage, infection, and endometritis. However, the given answer states that the benefit of VBAC over cesarean is not a reduced risk of endometritis. This implies that there might be no significant difference in the occurrence of endometritis between VBAC and cesarean births.

Twin gestations showed equal probability for success in VBAC when compared to singleton pregnancies and had no greater risk of uterine rupture.