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    May 30

    vbac and risk of rupture with history of infection of incision post-op; with history of extension of uterine incision during surgery

    Archived User

    I am in the process of writing a protocol for my home birth practice and vbac.  In my reading of various sources I have seen mention of history of infection of a previous incision with c-section as well as extension of the incision being cited as reasons to risk out a client for vbac.  I haven't been able to find any evidence regarding these findings and increased risk for uterine rupture in labor.  Do you know of any such evidence?


    Janet Schwab, MSN, CNM

    To Each Her Own Women's Health Services, LLC



    Henci Goer

    I just skimmed the systematic review that underpinned the 2010 NIH VBAC conference, and the reviewers did not look at infection after the previous cesarean as an influence on scar rupture rates. I know it has been proposed as one, but I haven't run any searches on the issue myself. if you want to try and haven't already, this is PubMed's gateway, and there is a link to tutorials on that page on how to structure searches. I know that VBAC is not recommended for inverted T and J incisions, but I have not seen any research on incision extensions. The best data we have comes from an analysis the big Maternal Fetal Medicine Units Network cohort in which a mixed group of 105 women with classical, inverted T, or J incisions labored, among whom 2, or 2% experienced scar rupture. I would think this is high enough to contraindicate home birth, but I don't know if this should be extrapolated to incision extensions. Maybe you can find something in PubMed as well. I'm sorry that I can't be more help.

    -- Henci

    Archived User

    Thank you.  This information is very helpful.

     Janet Schwab, MSN,CNM

    Henci Goer

    You're welcome. ~ Henci

    All Times America/New_York

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