U2 Ob - Et 32 Obstetric Procedures: Vbac

Suspected macrosomia refers to a condition where the fetus is estimated to have a larger than average birth weight. This question is asking whether a trial of labor should be ruled out for a patient who has previously had a Cesarean delivery and is suspected to have macrosomia. The correct answer is true, indicating that suspected macrosomia should not automatically prevent a trial of labor in this scenario. This is because there are various factors that need to be considered, such as the patient's overall health, the size of the baby, and the previous Cesarean delivery's reason. Each case should be evaluated individually to determine the safest course of action.

Most maternal morbidity that occurs during a trial of labor occurs when repeat Cesarean delivery becomes necessary. This is because repeat Cesarean deliveries carry a higher risk of complications compared to vaginal deliveries. These complications can include infection, blood loss, injury to surrounding organs, and longer recovery time. Therefore, it is true that most maternal morbidity during a trial of labor occurs when repeat Cesarean delivery becomes necessary.

All of the factors mentioned in the options can decrease the chances of having a successful VBAC (Vaginal Birth After Cesarean). Recurrent indication for initial Cesarean delivery means that if a woman has had multiple previous Cesarean deliveries, it reduces the likelihood of a successful VBAC. Gestational age greater than 40 weeks can increase the risk of complications during labor and delivery, making a VBAC less likely. Induction of labor, especially with medications like oxytocin, can increase the chances of uterine rupture, which is a major concern in VBAC. Maternal obesity is associated with an increased risk of complications during pregnancy and delivery, including a higher likelihood of Cesarean delivery. Therefore, all of these factors can individually or collectively decrease the chances of a successful VBAC.

Prior spontaneous vaginal delivery increases the chances of a successful VBAC because it indicates that the patient has previously had a successful vaginal delivery without complications. This suggests that her pelvis is adequate for vaginal delivery and that she may have a lower risk of complications during labor.

The sudden onset of prolonged fetal bradycardia that does not resolve with a change in maternal position or the administration of oxygen suggests uterine rupture. Uterine rupture is a rare but serious complication of labor after a previous cesarean delivery. It occurs when there is a tear in the wall of the uterus, which can lead to fetal distress and compromise. In this case, the patient's history of a prior cesarean delivery and the presence of contractions every 3-4 minutes indicate that she is in active labor, increasing the risk of uterine rupture.

Discussions about VBAC (Vaginal Birth After Cesarean) should begin at an early prenatal visit with a patient who has had a prior Cesarean delivery. This is because it allows the healthcare provider to assess the patient's medical history, evaluate the factors that led to the previous Cesarean delivery, and discuss the risks and benefits of attempting a VBAC. Starting the discussion early in the prenatal period gives the patient enough time to make an informed decision and plan for the birth accordingly. It also allows for any necessary preparations or interventions to be made in advance.

In order for a facility to offer a VBAC (Vaginal Birth After Cesarean), it is necessary to have an obstetrician skilled in emergency Cesarean delivery in-house. This is because in the event of any complications or emergencies during the VBAC, the obstetrician should be capable of performing a Cesarean delivery immediately. Having this requirement ensures the safety and well-being of both the mother and the baby during the delivery process.

Misoprostol should not be used in a patient attempting a VBAC (Vaginal Birth After Cesarean). Misoprostol is a medication that is commonly used to induce labor or ripen the cervix. However, it is contraindicated in patients attempting a VBAC because it can increase the risk of uterine rupture. Uterine rupture is a serious complication that can occur during labor and delivery, and it is more likely to occur in patients who have had a previous cesarean section. Therefore, it is important to avoid using medications like misoprostol that can increase the risk of uterine rupture in patients attempting a VBAC.

In a trial of labor, the patient is attempting a vaginal delivery after a previous cesarean section. This means that the patient has already had a cesarean delivery in the past, which increases the risk of uterine rupture during a subsequent vaginal delivery. However, in this case, the patient is at a lower risk of uterine rupture because she is only in active labor and has not yet delivered. On the other hand, hemorrhage is a common complication of both vaginal and cesarean deliveries. Therefore, the patient will have the risk of hemorrhage lowered most significantly by attempting a trial of labor.

The correct answer is C, D, E. Contraindications to VBAC (vaginal birth after cesarean) include a prior classical uterine incision, multiple uterine surgeries, and contraindications to vaginal birth. These factors increase the risk of uterine rupture during a VBAC attempt and may require a repeat cesarean delivery instead. Previous vaginal delivery and an adequate pelvis are not contraindications to VBAC.