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VBAC in previous C sections and placental abruption

Resolved Question:

Hello I am a 32 year old G2P2002 both by C-Sections births. My son was born January 18, 2007. This is my 1st son's record report...

"Failed induction of labor with Pitocin and Foley bulb and underwent a low segment transverse C-Section of live born infant male. Apgars were 8 and 9." ..."The patient had an induction with Foley, bulb, and Pitocin. She progressed to 7, 90, and 0 station, and after several hours of adequate contractions, the patient failed to progress.

Preoperative Diagnosis:
*Para 0 at 41-2/7
*Failed induction of labor
*Arrest of dilation

Postoperative Diagnosis:
*Uterine atony
*Cephalopelvic Disproportion

My daughter was born on her due date May 31, 2007. I attempted to have a VBAC with my daughter, but it failed due to placental abruption. My ROM showed blood clots, so my doctor rushed me back to the OR for a C-section.

My question is I would like to have another baby and try for a VBA2C. I know this is a controversial issue and according to ACOG it is safe to have a vaginal birth after 2 C-sections for some women.

On my daughters record it says C-Section due to placental abruption (likely chronic). I can't find anything on chronic placental abruption. Obviously I can't have a VBA2C if I have another placental abruption.

Does my past history of having a placental abruption keep me from having a trial of labor and hopefully VBA2C with my next child?


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,

Thanks for your query at DoctorSpring.com.

Firstly, according to the latest ACOG guidelines , it is safe for women with two previous C sections to attempt VBAC.

Earlier guidelines were restrictive, and discouraged women with 2 previous sections from attempting the same.

As you have noted, it is a controversial issue - when you plan VBAC, you run the calculated risks of sudden scar rupture, haemorrhage, rupture of the uterus, fetal loss and hysterectomy or even death.

The percentages of these risks is low, hence ACOG recommends that a trial should be attempted in women who are adequately counselled and voluntarily opt to try for a VBAC.

Regarding the indications mentioned by you, placental abruption has a recurrence of around 10 %. The previous indication has me more worried. Cephalopelvic disproportion means that the baby's size was more than the size of your pelvis ( cephalos - head ). Hence, if the next time around, your growth scans show a large baby, then I would not recommend VBAC for obvious reasons ( high risk of failure and rupture of the uterus ).

Also, ACOG recommends VBAC for women with two prior Lower segment C sections.
In the operative details provided by you, this has not been mentioned, but I assume that the sections were lower segment ones, since upper segment ones are quite rare and for unique situations.

Hence, in your case, you can opt for VBAC in a well equipped centre with rigorous monitoring for the earliest signs of complications. As long as you understand the risks and are willing to participate in the procedure, then yes, you can go for VBAC in your next pregnancy. A previous placental abruption is no reason for you not to opt for VBAC.

Obviously, if next time around you have a breech baby, or twins, or some other reason that mandates a repeat C section, then VBAC is out of question.

I hope this answer helped you.
Please feel free to discuss further with me if you have any doubts.
All the best.

Regards


Patient replied :

Sorry, My daughter was born May 31, 2008 (not 2007 that would be impossible).


Expert:  Dr. Aarti Vazirani replied 3 Days.

Thank you very much for your response. :)


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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