Κατεύθυνση Παθολογία της Κύησης
Library of the School of Health Sciences

2019-07-16

2019

Leskai Gkratsiela

Παπαντωνίου Νικόλαος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κασσάνος Δημήτριος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρέλιας Χαράλαμπος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Κολπικός τοκετός μετά από καισαρική τομή

Greek

Vaginal birth after cesarean section

INTRODUCTION: Before the 1970s, the phrase "once a caesarean, always a caesarean" dominated obstetric practice in the United States and around the world. As surgical techniques became safer in the 1970s, cesarean rates began to increase.
With almost 1.5 million caesarean sections being performed each year, it is the most common surgery in America. Similarly, over the last decades, cesarean rates in Greece have risen dramatically. To compensate for the increasing trend in caesarean section, international organizations are recommending vaginal delivery after caesarean section as a safe and reasonable alternative for carefully selected women.
MATERIAL AND METHODS: The aim of this study is to conduct a literature review of vaginal birth after caesarean as well as to provide valuable up to date information to the health professionals involved in childbirth. Electronic databases such as Pubmed, Google Scholar, Wikipedia, Cochrane, Uptodate, MedLine have been used.
RESULTS: For women who have had a caesarean, the choices for mode of birth in their next pregnancy are either a trial of vaginal birth after caesarean or an elective repeat caesarean. One of the biggest challenges of counseling and managing women with one prior caesarean is the inability to accurately identify women who have a high VBAC chance and those who have an increased risk of morbidity. One of the most potent prognostic factor for VBAC is previous vaginal delivery. Studies systematically indicate that women with vaginal birth history have a higher probability of VBAC than women who do not have prior vaginal birth experience.
Another big challenge, for women who have had a previous cesarean section, is whether labour should be induced. Although trial of labor after cesarean in women with one prior low transverse cesarean section is considered safe, the risk of uterine rupture associated with induction of labor may be increased.
Uterine scar rupture is often sudden and can be devastating, and there are no precise prognostic factors. However, the most common sign of uterine rupture is an abnormality in the fetal heart rate, which has been associated with up to 70% of the cases of uterine rupture.
CONCLUSION: A pregnant woman with one prior caesarean section is at risk for maternal and perinatal complications, regardless of whether she is going to attempt a vaginal birth or whether she chooses an elective repeat cesarean section. The complications of both procedures should be discussed and an attempt should be made to individualize the risk of uterine rupture and the likelihood of successful VBAC. Forming a preference for repeat caesarean or VBAC is a process shaped by a variety of medical, obstetric and neonatal factors.

Health Sciences

Vaginal birth after cesarean section, Cesarean section, VBAC, Uterine rupture, Maternal mortality, Perinatal death, Predictors of vbac, Trial of labor, Induction of labour

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https://pergamos.lib.uoa.gr/uoa/dl/object/2878113