Saturday, July 31, 2010
Risky obstetric advice
August 2009
A patient was pregnant with twins recently — her third pregnancy after two C-sections (initially due to severe sciatica). Her obstetrician suggested a “trial of labour,” even though her scar was noted to have been “paper thin” on the second C-section. How advisable would this have been? As it turned out, she demanded a C-section and again a thin uterine wall was noted. SANDI C. FRANK, MD, Edmonton, AB
The most recent SOGC guidelines on vaginal birth after Caesarean (VBAC) state that a trial of labour in women with more than one previous Caesarean is likely to be successful but that it is associated with a higher risk of uterine rupture — 1.7% to 3.7%, which is up to almost 5 times higher. Multiple gestation is not a contraindication to attempting a VBAC, but if a trial of labour is attempted, it should be done in a facility where timely Caesarean section facilities and staff are available. Having said all of this, most obstetricians would be reluctant to allow a woman with twins and 2 previous Caesareans to attempt a VBAC, especially if they’re delivering within 18 to 24 months of their last Caesarean section.
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- 2008 Update
