August 18, 2007

ACO.G guidelines for VBAC

I found a link that summarizes AC.OG guidelines for VBAC and I included it at the bottom. This was the best I could find since I'm not a member of AC.OG.

Criteria for selecting candidates for VBAC include the following: (1) one previous low-transverse cesarean delivery; (2) clinically adequate pelvis; (3) no other uterine scars or previous rupture; (4) a physician immediately available throughout active labor who is capable of monitoring labor and performing an emergency cesarean delivery; and (5) the availability of anesthesia and personnel for emergency cesarean delivery.

The following recommendations are based on good and consistent scientific evidence :
Most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean delivery (VBAC) and should be counseled about VBAC and offered a trial of labor.
Epidural anesthesia may be used for VBAC.

The following recommendations are based on limited or inconsistent scientific evidence :
Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.
The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged.

The following recommendations are based primarily on consensus and expert opinion :
Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.
After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.
Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery.

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