What is the best mode of delivery for 30 years old lady G4P3 at 36 weeks period of gestation with history of two previous cesarean section? Will you allow her for VBAC?
From the Evidence Based
For women with 2 prior cesarean deliveries, only those with a prior vaginal delivery should be considered candidates for a spontaneous trial of labor. [ACOG, 2004]
Women with a prior history of two uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term, with no contraindication for vaginal birth, who have been fully informed by a consultant obstetrician, may be considered suitable for planned VBAC.[Green top no 45,2007]
However,
Note that even one cesarean section will put patient in danger of uterine rupture. The risk will increase with more cesarean section. Therefore, mode of delivery in these patient should be discussed and planned carefully between the O&G specialist and patient.
For undergraduate student, the examiner would like to access how safe are you in managing the patient. If you are not confident in giving argument to support VBAC, then it is better for you to answer elective cesarean section. It is more SAFE. Common practice in Malaysia is to allow up to only 4 cesarean section and followed with bi tubal ligation.
I too had c-sec with my 1st and 2nd child. The 1st is because baby pass motion need emergency c-sec in private clinic. The 2nd one - poor progress of delivery after waiting for 8 hours since my water broke in a govt hosp. Hence for 3rd child I opt for another priv. hosp. and discuss with my gynae I want a normal delivery - VBAC and a success. Now my 4th child is also born by VBAC by the same gynae....
ReplyDeletemay i know the priv hosp n gynae that support vba2c?
DeleteHi could you please help me give the details of the private hospital that provide vb2c..many thanks
DeleteHi could you please help me give the details of the private hospital that provide vb2c..many thanks
DeleteHi could you please help me give the details of the private hospital that provide vb2c..many thanks
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