Re: Vbac after 3 sections

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Gosh

The risks associated with VBAC are dehiscence or rupture of the uterus. The risk of this after one C/S is 1.7% compared to 1.1% if no VBAC occurs (i.e. in many cases the uterus has seperated prior to the labour). This excess risk of 0.6% after one C/S is offset against the risk of a fever following the C/S so most gynaecologists encourage VBAC after one scar.

The risk of rupture after 2 C/S is 3.3%. Many gynaecologist advise repeat C/S after 2 C/S. However, there are some studies suggesting it is safe and therefore controlled and carefully observed labour is acceptable after going through the pros and cons. However, the evidence for safe VBAC after 2 scars is not as good as after one. There is really very little evidence of the safety of VBAC after 3 scars. We just can't give you a figure as to what the risk of uterine rupture is. Most gynaecologists would therefore be unhappy with a VBAC in these cases. However, these decisions are made jointly. If you have decided to go for a VBAC after 3 scars aware that we don't know the exact risks, then the correct compromise would be to have a drip up so if anything does go wrong, then the doctor can attend an emergency immediately (drips can be difficult to put up if you have bleeding).

Best of luck

--
Dr Thomas Ind MB BS MD MRCOG
St George Hospital
Kogarah
Sydney
NSW 2217
AUSTRALIA

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