Uterine rupture risk drops with each VBAC
When planning the size of your family, considering the implications of multiple cesareans versus multiple VBACs.
As we know, the risks of cesareans goes up with each surgery, especially in terms of adhesions.
But, as this study found “VBAC success increased with increasing number of prior VBACs” and “the rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter.”
I’d love to know if they induced or augmented these women and if the rates of rupture were lower in spontaneous and non-augmented labors like Landon 2004 found. I’d also like to read more about the “low risk for maternal and neonatal complications.” How do their results compare with the 1 in 2000 “adverse perinatal outcome” Landon 2004 found? Maybe I’ll pay the $20 for single day access to find out. I’ll keep you posted.
Mercer BM, Gilbert S, Landon MB. et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstet Gynecol. 2008 Feb;111(2):285-291.
ABSTRACT
OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
LEVEL OF EVIDENCE: II
It would be nice if the site shows doctor names who allow VBAC. My and alot of my friends are looking for ones in CA, but still no results.
This would be a great profit idea for the VBAC doctors.
[...] Рискът от усложнения нараства с увеличаване на броя на цезаровите сечения, както и рискът от руптура при следващи бременности, също така рискът от руптура намалява с 50% след първото VBAC. (Mercer 2008) [...]
After having an emergency CS for a breech baby with my second, I have had three VBACs in the last 4 years. It’s been difficult to find docs that will allow me a VBAC but the group I’m with now is really anxious to not put me under the knife. With all three VBACs I’ve been given Pitocin and my last was an official induction as I was not in active labor by my due date.
[...] Additionally, the risk of complications increase with each RCS including your risk of UR in future pregnancies, whereas the risk of UR decreases by 50% after your first VBAC. (Mercer 2008) [...]