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Vaginal Birth after Cesarean
Management of Suspected Fetal Macrosomia - Article
ABSTRACT: Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. It is associated with increased risks of cesarean section and trauma to the birth canal and the fetus. Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetal weight are prone to error. Elective cesarean section for suspected macrosomia results in a high number of unnecessary procedures, and early induction of labor to limit fetal growth may result in a substantial increase in the cesarean section rate because of failed inductions. Pregnancies complicated by fetal macrosomia are best managed expectantly. When labor fails to progress as expected, the possibility of fetopelvic disproportion should be considered within the context of the best estimate of the fetal weight.
ABSTRACT: Vaginal birth after cesarean section is common in this country. Physicians providing obstetric care should be aware of the potential complications. Uterine rupture occurs in approximately one of every 67 to 500 women (with one prior low-transverse incision) undergoing a trial of labor for vaginal birth after cesarean section. Rupture poses serious risks to mother and infant. There are no reliable predictors or unequivocal clinical manifestations of rupture, so physicians must maintain a high index of suspicion for possible rupture, especially in the presence of fetal bradycardia or other evidence of fetal distress. Management is surgery for prompt delivery of the infant and control of maternal hemorrhage. Newborns often require admission to an intensive care nursery. Prevention of poor outcomes depends on thorough anticipation and preparation. The physicians and the delivery institution should be prepared to provide emergency surgical and neonatal care in the event of uterine rupture.
Predicting the Likelihood of Successful Vaginal Birth After Cesarean Delivery - Point-of-Care Guides
Responding to a Colleague Who Neglects Best Practices - Curbside Consultation
VBAC: Protecting Patients, Defending Doctors - Editorials
ACOG Urges a Cautious Approach to Vaginal Birth After Cesarean Delivery. - Special Medical Reports
ACOG Urges a Cautious Approach to Vaginal Birth After Cesarean Delivery - Special Medical Reports