ACOG Practice Bulletin No. 205 Summary: Vaginal Birth After Cesarean Delivery.

Authors:

Obstet Gynecol 2019 Feb;133(2):393-395

Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (1-3). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4-6). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000003079DOI Listing
February 2019
2 Reads

Publication Analysis

Top Keywords

cesarean delivery
28
trial labor
12
delivery
9
birth cesarean
8
previous cesarean
8
vaginal birth
8
vaginal delivery
8
cesarean
7
successful trial
4
decreased maternal
4
morbidity decreased
4
candidate tolac
4
complications future
4
tolac clinical
4
risk complications
4
clinical situations
4
compared successful
4
decreased risk
4
maternal morbidity
4
appropriate candidate
4

Similar Publications