OB-GYN-L Messages for January, 2005: Re: VBAC

Re: VBAC

From: Anna Meenan, MD

annam@uic.edu

Sat Jan 15 00:13:02 2005

-- Anna Meenan, MD

At Fri, 14 Jan 2005, David Priver, MD wrote: > >Well, what I meant by the remark that this is a low risk situation is >that if there is a problem of integrity of her uterine scar, it seems >extraordinarily unlikely that it would not have manifested itself in one >of the prior six deliveries and suddenly do so now. I really can't >follow the logic of approving her last six vaginal deliveries and now >insisting on a change of plans. A 7th VBAC followed by a long overdue >PPTL would be my preference, assuming, of course, that one works in a >facility prepared to handle an emergency. For what it's worth, are >there really OB units in this day and age in this country where such >capability does not exist? I mean, don't all OB units have to be able to >handle a wide variety of emergencies such as prolapsed cords, >abruptions, etc. in which an OB and at least one anesthesiologist are >in house 24 hours a day? I'd hate to work somewhere where that was not >the case. >DP > >At Thu, 13 Jan 2005, Efrain Ramirez wrote: >> >>I agree that a repeat C/S and Tl is the best way here - but how can you >>be so sure of your statement that six succesful VBAC's is as low you can >>possibly ask... >> >>This study looks at patients with only one -- the patient been discussed >>has two scars - I would not be so confident .. >> >>Obstetric and perinatal outcome of women para >>Ali AM, Abu-Heija AT >> >>J Obstet Gynaecol Res (2002 Jun) 28(3):163-5 ISSN: 1341-8076 >> >>Parity >>Pregnancy Outcome >>Surgical Wound Dehiscence >>Uterine Rupture >>Vaginal Birth after Cesarean >> Adult >>Female >>Human >>Pregnancy >>Retrospective Studies >> >> Abstract >> >>OBJECTIVE: To study the prevalence of antenatal, intrapartum and >>postnatal complications and their perinatal outcome in women who are >>delivering for the 6th time and have also had one cesarean section. >> >>METHODS: The records of all women para > or = 5 with one previous >>cesarean section (n = 238) delivered at King Fahd Hospital of the >>University between the January 1 1994 and December 31 2000 were reviewed >>and compared with women who delivered at the hospital in the year 2000 >>(n = 2470). This data was analyzed for the peripartum and perinatal >>outcome. >> >>RESULTS: The incidence of malpresentation was higher in the study group. >>The incidence of uterine rupture and uterine scar dehiscence was >>significantly higher in the study group, but there was no perinatal or >>maternal death associated with this and in all cases the uterus was >>preserved. More women managed to deliver vaginally after the cesarean >>section in the grandmultiparous women compared with the women in the >>control group (81.5% vs 63.0%) P < 0.00006, where the cesarean section >>rate was significantly higher (P < 0.02). There were no significant >>differences in the incidences of preterm labor, lethal malformations, >>stillbirths and neonatal deaths in the two groups of women. There was >>one case of cesarean hysterectomy in each group due to placenta accreta >>and atonic postpartum hemorrhage, and one maternal death in the control >>group. >> >>CONCLUSION: Grandmultiparous women with one previous cesarean section >>have an increased risk of operative delivery, scar dehiscence, but there >>is no increase in perinatal or maternal mortality. >> >>At Thu, 13 Jan 2005, David Priver, MD wrote: >>> >>>Dear friends, >>>This forum is a lot like a soap opera: you can miss a few days and come >>>back to find they're still on the same subject. Not sure what we'd do >>>for discussion if it weren't for VBAC. You say she's had six successful >>>VBACs in a row? Sounds to me like about as low a risk for rupture as you >>>could possibly ask for. I think I'd focus my efforts on getting her to >>>sign a tubal ligation consent. >>>DP >>> >>>At Thu, 13 Jan 2005, Laor wrote: >>>> >>>>--Boundary_(ID_BLyugwPFGzlTPJqY9RhkSw) >>>>Content-type: multipart/alternative; >>>> boundary="Boundary_(ID_f51/FxWUeHaurCJ0K8Dm3w)" >>>> >>>>--Boundary_(ID_f51/FxWUeHaurCJ0K8Dm3w) >>>>Content-type: Text/Plain; charset=windows-1255 >>>>Content-transfer-encoding: quoted-printable >>>> >>>>she is gmp and as it seems to me she already demonstrated 6 nvd's so you >>>>should be presentduring the delivery and prepare the patient to possibil ty >>>>of cs and of the remote chances of rupture dic hysterectomy! >>>>Danny Laor ob-gyn jerusalem >>>> >>>>-------Original Message------- >>>> >>>>From: ob-gyn-l@obgyn.net >>>>Date: 01/13/05 11:41:55 >>>>To: Multiple recipients of list OB-GYN-L >>>>Subject: VBAC >>>> >>>>I know we have dealt with the issue of VBAC on multiple occasions in this >>>>forum before, but I’m rereading the July 04 technical bulletin again o VBAC >>>>and I’m interested in the group’s views on risk after subsequent suc essful >>>>VBAC. >>>> >>>>-- >>>> >>>>I have a 36 yo G11 P8028 now at 24 wks. Her first two deliveries were >>>>sections and the last 6 were term VBAC. She would like to VBAC again. >>>> >>>>Currently, we do not offer any VBACs at this facility but I’m looking >>>>specifically for risk for her sake. >>>> >>>>The technical bulletin states that only women with a “prior vaginal >>>>delivery” are candidates for VBAC after 2 sections. Does this include those >>>>that both have delivered before the sections AND after the sections? >>>> >>>>I’ve found three articles that seem to all point toward a substantially >>>>reduced risk of uterine rupture after having a successful VBAC. Of cour e >>>>none address 6 prior successful VBACs! >>>> >>>>Thanks, >>>> >>>>Glen >>>> >>>>D. Glen Elrod, Maj USAF, MC >>>>Obstetrician/Gynecologist >>>>Maternal Child Flight >>>> >>>>48 MDOS/SGOBO >>>>UNIT 5210 Box 23 >>>>APO, AE 09464 >>>>DSN (314) 226-8334 >>>>Comm 01638-52-8334 >>>> >>>>Notice of Confidentiality >>>>Under the Privacy Act of 1974, you must safeguard all information reflec ed >>>>on this Email and, if applicable, all attachments. Disclosure of >>>>information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI >>>>33-219, and PL 93-579” >>>>This document may contain information covered under the Privacy Act, 5 U C >>>>552(a), and/or the Health Insurance Portability and Accountability Act ( L >>>>104-191) and its various implementing regulations and must be protected n >>>>accordance with those provisions. Healthcare information is personal and >>>>sensitive and must be treated accordingly. See <https://sg.usafe.af >>>>mil/HIPAADisclosure.cfm> for full details. >>>> >>>>--Boundary_(ID_f51/FxWUeHaurCJ0K8Dm3w) >>>>Content-type: Text/HTML; charset=windows-1255 >>>>Content-transfer-encoding: quoted-printable >>>> >>>><BODY style="BACKGROUND-POSITION: left 0px; FONT-SIZE: 12pt; MARGIN: 0 x 10px 10px 25px; COLOR: #3a3570; BACKGROUND-REPEAT: repeat; FONT-FAMILY MS Sans Serif" text=#3a3570 bgColor=#fafefd background=cid:7D4BCB B-F223-4AA2-8B85-66159A454543 scroll=yes SIGCOLOR="11031552" ORGYPOS== >>>>"0"> >>>> >>>>she is gmp and as it seems to me she already demonstrated 6 nvd's s you should be presentduring the delivery and prepare the patient to pos ibility of cs and of the remote chances of rupture dic hysterectom ! >>>>Danny Laor ob-gyn jerusalem >>>> >>>>-------Original Message------- >>>> >>>> >>>>From: ob-gyn-l@obgyn.net >>>>Date: 01/13/05 11 41:55 >>>>To: Multiple recipients of list OB-GYN-L >>>>Subject: VBAC >>>> >>>> >>>>I know we have dealt with the issue of VBAC n multiple occasions in this forum before, but I’m rereading the July 4 technical bulletin again on VBAC and I’m interested in the group’s views on risk after subsequent successful VBAC. /P> >>>> >>>>I have a 36 yo G11 P8028 now at 24 wks. Her first two deliveries were sections and the last 6 were term VBAC.&n sp; She would like to VBAC again. >>>> >>>>Currently, we do not offer any VBACs at this facility but I’m looking specifically for risk for her sake. >>>> >>>>The technical bulletin states that only wome with a “prior vaginal delivery” are candidates for VBAC after 2 sec ions. Does this include those that both have delivered before the ections AND after the sections? >>>> >>>>I’ve found three articles that seem to all point toward a substantially reduced risk of uterine rupture after havin a successful VBAC. Of course none address 6 prior successful VBAC ! >>>> >>>>Thanks, >>>> >>>>Glen >>>> >>>>D. Glen Elrod, Maj USAF, MC >>>>Obstetrician/Gynecologist >>>>Maternal Child Flight >>>><SPAN style== >>>>"FONT-SIZE: 12pt"> >>>> >>>>48 MDOS/SGOBO >>>> >>>>UNIT 5210 Box 23 >>>> >>>>APO, AE 09464 >>>>DSN (314) 226-8334 >>>>Comm 01638-52-8334 >>>> >>>><SPAN style== >>>>"FONT-SIZE: 12pt"> >>>>Notice of Confidentiality Under the Priv cy Act of 1974, you must safeguard all information reflected on this Ema l and, if applicable, all attachments. Disclosure of information i IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 3-579”This document may contain information covered under the Priv cy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accoun ability Act (PL 104-191) and its various implementing regulations and mu t be protected in accordance with those provisions. Healthcare informati n is personal and sensitive and must be treated accordingly. See <https://sg.usafe.af.mil/HIPAADisclosure.c m> for full details.

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