VBAC and C Section Lecture Powerpoint

Question 1

Reasons for rising rate (4)

Answer 1

• almost 1/2 of pregnant women are nullipara, increasing risk of requiring c section
• older women having children
• breech presentation
• litigation

Question 2

Labor inductions do NOT increase rates of…

Answer 2

….c section

Question 3

Absolute indications for c section (5)

Answer 3

• significant abruption of placenta (complete abruption baby is dead)
• hemorrhage from placenta previa
• prolapse of umbilical cord
• active genital herpes infection
• impending maternal death

Question 4

Complications of c section are up to __% of patients

Answer 4

8% (this is actually close to being on par with vaginal birth as well

Question 5

C section complications (7)

Answer 5

• hemorrhage requiring transfusion
• endometriosis
• wound infection
• operative injury
• aspiration under anesthesia
• UTI
• thrombophlebitis and PE

Question 6

Indications for cesarean delivery (8)

Answer 6

• repeat
• dystochia** (most common)
• breech
• distress
• cord prolapse
• transverse lie
• abruption
• placenta previa

Question 7

Types of cesarean sections (4) and rupture rate

Answer 7

• classical (10%) (rarely done anymore)
• T shaped (10%)
• low vertical (7%)
• low transverse (1.5%) (much lower risk!)

Question 8

TLAC and VBAC

Answer 8

Trial of Labor after C-section, Vaginal Birth after C-section

Question 9

Contraindications to VBAC (2)

Answer 9

• Previous classical uterine incision

- suspected macrosomia in diabetic patient

Question 10

Candidates for VBAC (4)

Answer 10

• one prior low transverse c section if there were previous vaginal births
• women with 2 low transverse c sections if successful vaginal birth prior to first
• clinically adequate pelvis
• availability of obstetritian and team for emergency c section

Question 11

Uterine rupture

Answer 11

Partial or complete rupturing of previously sealed uterus, diagnosed via sudden severe fetal heart rate deceleration and bradycardia, abdominal pain, loss of station of presenting part of baby, shoulder or chest pain

Question 12

Uterine rupture prognosis

Answer 12

• 50-75% mortality rate of fetus
• seldom fatal to mother
• 20% of mothers will require hysterectomy to control hemorrhage

Question 13

Elective cesarean section principles

Answer 13

-mortality and morbidity is near identical to vaginal, vaginal is responsible for urinary incontinence, rectal incontinence, uterine prolapse, etc., it avoids painful labor, it can be scheduled, slighlty statistical higher iq compared to vaginal

Question 14

___ doubled in subsequent pregnancy delivered by c section

Answer 14

Placenta previa

Question 15

____ increased in pregnancies after one cesarean section

Answer 15

unexplained stillbirth

Question 16

Risks for infant in c section (1)

Answer 16

-incision of the fetus upon uterine opening (1/100 chance)

Question 17

Objective benefits of C section (4)

Answer 17

• protection of the pelvic floor
• avoidance of emergency cesarean
• spare fetus risk of dystocia
• slightly safer to be born via repeat cesarean for infant mortality rates

Question 18

Veracity

Answer 18

Ethical principle of healthcare providers to tell truth to the patient about risk and benefits of any procedure/drug in order for them to make the best decision for themselves

Question 19

Is it ethically necessary to initiate discussion regarding the relative risks and benefits of elective c section birth in every pregnant patient?

Answer 19

No, unless they ask