WOMENS-HEALTH Messages for June, 1998: Re: Dr's opinions on VBAC with didelphys uterus?

Re: Dr's opinions on VBAC with didelphys uterus?

From: William D. McIntosh, MD (anonymous@obgyn.net)
Tue, 30 Jun 1998 12:34:52 -0500 (CDT)

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In reply to: ann: "Dr's opinions on VBAC with didelphys uterus?"

At Tue, 30 Jun 1998, ann wrote: >
>Doctors,
>
>I am gathering information for a friend who is pregnant with her second
>child and hoping you'll be able to help. She has received varying
>answers from her past doctor and her persent doctor. What would your
>general opinions be on this situation?? She has a didelphys uterus, in
>which she has 2 uteri, 2 cervixes, and a vaginal septum. The uteri are
>separate from each other. Her previous pregnancy ended with a C-section
>for various reasons: 1)she was induced due to PIH and post-term fetal
>status without any sign of imminent labor and failure of cervical
>ripening agents, but was unable to continue induction due to fetal
>compromise with Pitocin use & 2) baby's positioning was improper (not
>positive, but believe was breech with head extended). Now she is
>pregnant again and wondering about the possibility of VBAC, the safety,
>risks, especially regarding her uterine abnormality. I do not know if
>this is a factor, but she is significantly overweight as well. Her past
>doctor believes VBAC would be safe and possible, while her present
>doctor believes VBAC is riskier in her case. What are your opinions on
>this? Thank you for any insight you may offer.
>
>--
>Ann
>

I will assume for the sake of arguement that your friend had a low transverse c-section. I would allow her to try VBAC in the event that the fetus were vertex, and there were not any other indications against vaginal delivery. The biggest hurdle to overcome may well be the presentation. Breech is very common in this situation. The risks of uterine rupture with VBAC are no greater with a didelphys uterus than in a normal uterus.

-- William D. McIntosh, MD

This is not intended to replace consultation and examination by a medical practitioner.

Next message: Kelly Shanahan, MD: "Re: Testing for recurrent miscarriage, Dr. Shanahan"
Previous message: Natalie: "Suspected Polycystic Ovaries"
In reply to: ann: "Dr's opinions on VBAC with didelphys uterus?"

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