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Re: VBAC, Three previous CS.From: Luis Sanchez-Ramos (luis.sanchez@jax.ufl.edu)Sat Jan 29 18:32:15 2000
At Sat, 29 Jan 2000, Robert J. Carpenter, Jr. MD wrote: >>Since I would not/do not labor 3 prior c-sections<<
>> post conclusion of the pregnancy, let us know the outcome<< During the years 1990 & 1991 our cesarean rate (with over 5000 deliveries at a tertiary center)was 8.5 and 8.1%. A major contributor to our reduced cesarean rate was a policy of "mandatory trial of labor" for all patients with prior cesareans (except for those with classical scars). Several patients with >2 prior cesareans delivered without any problems. If I remember correctly, we even had a patient with 5 prior cesarean who had a VBAC. There are data in the literature of TOLs in patients with more than 1 prior cesarean. I'm not advocating a trial of labor for this particular patient. I'm just surprised to the reaction when the lister suggested she may desire a trial of labor. I'm not sure of the uterine rupture rate for patients with more than 1 prior cesarean: I would have to look it up. Nonetheless, the rate quoted from USC seems high. Many patients at USC had a trial of labor with "unknown" scars, many of which were classical cesarean operations performed in Latin America. LSR
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