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.
