There are various risks associated with VBAC, and these can be categorized into maternal and fetal risks. Uterine rupture, operative injury, blood transfusion, hysterectomy, endometritis, maternal death, and infection are mostly reported as maternal risks due to VBAC (Cox, 2014; Hill et al., 2012; Cahill et al., 2007; Emmett et al., 2007; NIH, 2010; Nilsson et al., 2015; Sabol et al., 2015).
By far, the most feared complication of VBAC is uterine rupture, which is defined as “an anatomic separation of the uterine muscle with or without symptoms” (NIH, 2010, p. 16). Due to complete separation of the uterine wall, there is accompanying risks for both mother and the fetus. According to Sabol et al. (2015), the absolute risk of uterine rupture is low in both trial of labor (0.47%) and ERCD (0.03%), however, significantly increased risks are found in women attempting VBAC (RR 20.74; 95% CI, 9.77-44.02; P <0.001). Although it is extremely impossible to prognosticate who will develop uterine rupture, proper canceling during prenatal period is important to make an informed decision by pregnant women.
The National Health Institutes also identified that approximately 325 per 100,000 women undergoing VBAC will develop uterine rupture at all gestational ages, and the risk will increase to 778 per 100,000 (NIH, 2010). In the same vein, uterine rupture was reported as 26 per 100,000 and 22 per 100,000 women who undergo ERCD at all ages and term respectively (NIH, 2010). Factors such as previous classical and vertical uterine scars, induction of labor, unfavorable cervical status at the time of admission, obesity, inter-pregnancy interval of 18 months or less, single-layer closure for the ...
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... carefully informed and counseled about the benefits and the risks of VBAC, study has found that many women will opt for VBAC because their perception of birth experience, initial parent-infant interactions, and ability to perform activities of daily living or initiate breastfeeding (Cox, 2014; NIH, 2010).
Unresolved questions associated with the practice of VBAC include: Should women with two prior cesareans undergo a VBAC, should women with twins undergo a VBAC attempt, how should patients undergoing a VBAC trial be handled intrapartum, and should the uterine scar be assessed manually after vaginal delivery? Women with previous cesarean delivery have a challenging and complex task of making decision on whether to undergo VBAC or TOLAC. This can be lessened if healthcare professionals inform these women about the benefits and risks associated with either procedure.
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