Saturday 30 May 2015

Vaginal birth after caesarean section


                Caesarean section or C-section is a surgical procedure used to deliver a baby through an incision made in the mother’s abdomen (laparotomy) and a second incision made in the mother’s uterus (hysterotomy). Meanwhile, vaginal birth after caesarean section or VBAC occurs when a woman having a vaginal delivery when she has had at least one baby by caesarean section previously.
               
                A woman underwent a caesarean section for few reasons. It can be due to maternal indication, or baby indication, or both. Maternal indications that lead to caesarean section include previous history of caesarean section, obstruction of birth canal such as tumor in the birth canal causing delivery to be obstructed, and pelvic abnormalities such as small pelvis. Fetal indications include breech, congenital malformation, compromised fetal condition, and so on.

                Every procedure will have its own complication. Same goes with C-section. Complication that may arise from C-section include infection which can arise from the wound itself or from other source such as urinary tract infection, thromboembolic disease such as deep vein thrombosis, anesthetic complication, injury to adjacent organ of the uterus such as bladder and bowel, uterine atony which the uterus unable to contract well after delivery causing bleeding from the uterus and so on.

                Maternal complications increase with Caesarean delivery relatively compared to a vaginal delivery. Thus VBAC may avoid some of the suitable candidate from encounter complication of C-section. However, not all candidate is suitable for VBAC. This is because there is risk for ‘uterine scar rupture’ for those who opted for VBAC. Therefore, candidates with high risk for uterine scar rupture are not suitable for this option, and they have to proceed with C-section.

                There are few criteria to be considered before making VBAC an option for delivery: 1) One previous low transverse C-section. 2) Clinically adequate pelvis. 3) No other uterine scar / previous uterine scar rupture. 4) A physician immediately available throughout active labor who is capable of monitoring labor and performing an emergency delivery (when indicated). 5) Availability of anesthesia and personnel for emergency C-section.

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