Subsequently, first in 2007 and then in 2015, Royal College of Obstetricians and Gynaecologists (RCOG) published new Guidelines for VBAC that planned VBAC is a clinically safe choice for most women with a single previous lower segment caesarean delivery ( 2). ![]() In 1988, ACOG published ‘Guidelines for vaginal delivery after a previous caesarean birth’ endorsing vaginal birth after Caesarean delivery (VBAC)-TOL as it became clear that this procedure was safe and did not appeared to be associated with appreciable excess perinatal morbidity, compared with elective CS. Increasing experience with VBAC has caused a gradual easing of selection criteria for trial of labour (TOL), reflected in the clinical practice guidelines. Since that time, encouraging women to attempt VBAC has been one of the strategies used in an attempt to reduce Caesarean delivery rates. In 1981, vaginal birth after CS, was recognized as a safe and acceptable option after a previous low transverse Caesarean delivery ( 1), though vaginal birth after caesarean (VBAC) is not without its own risks, which include uterine rupture, endometritis, blood transfusion. Maternal complications associated with elective repeat CS include placenta accrete, visceral injury, intensive care unit admission, hysterectomy, blood transfusion, and a longer duration of hospital stay. Studies have demonstrated that neonates of mothers who undergo elective repeat CS can be at greater risk of respiratory morbidity. This has implications not only at an economic level, but also in terms of maternal and neonatal morbidity. Repeating a CS came to account in almost 40% of all CS. Introductionīefore 1970s, the phrase “once a Caesarean, always a Caesarean’’ dictated obstetrics practice, in fact Caesarean section (CS) rates steadily increased throughout the twentieth century. Attempted VBAC will be successful in the majority of attempted cases. There are few absolute contraindications to attempted VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases. Success rates decrease when interval increases. An inter-pregnancy interval of <24 months is not associated with a decreased success of VBAC. Foetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. ![]() A non recurring indication for previous Caesarean section (CS), such as breech presentation or foetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). To determine antenatal factors that may predict successful vaginal birth after Caesarean section (VBAC), to develop a relevant antenatal scoring system and a nomogram for prediction of vaginal birth after caesarean delivery.
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