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Re: VBAC and uterine ruptureFrom: Darach Corcoran (djdc@iol.ie)Fri Apr 5 15:50:41 1996
Robert Brenner writes:- >If we as practicing Obstetricians are going to practice VBAC, then we need >more information as to which patients are at greater risk for uterine >rupture. What I think needs to be created is a registry of patients with >ruptured uteri so that we can ascertain what factors increase the risk. >Until more information is available, I must admit that my enthusiasm for >VBAC is rapidly diminishing. I have never regretted doing a repeat >C-section but have regretted attempting a vaginal delivery. Obviously, the >patient who's baby is in the NICU feels the same way. I can well see that a case like this would diminish enthusiasm, but it would be very wrong to make clinical decisions on such subjective grounds. In Ireland and the UK, practice has for many years been to always consider VBAC after one CS where the original LSCS indication was non-recurrent (and of course it was a lower segment CS). We have not had evidence to reconsider this policy to date. If you just study uterine ruptures you will probably find some problems in labour management. I feel however one must equally consider the complications of Caesarean section, which are not inconsiderable. Regards, Darach
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