care for overdue VBAC-er

Archived User

care for overdue VBAC-er
What would be the recommended course for a VBAC mom who is 42 weeks and showing no sign of impending labor?
When does inducing become less dangerous than going over 42 weeks, or even 43?
I know the studies show that uterine rupture is rare and death as a result even rarer, but are there studies about VBAC and post dates or can one put the different studies together and deduct?
And last, though this may be impossible to answer: if someone is that person to fall within that x small percent, what are the main issues that should have been looked at? The VBAC or the post dates, or both and why?

Henci Goer

RE: care for overdue VBAC-er
(in response to Archived User)

Studies of labor induction in women planning VBAC consistently find decreased likelihood of VBAC and almost all show increased likelihood of scar rupture. This makes sense. If the woman's uterus isn't ready to labor, forcing it will result in longer, harder contractions than she would have had on her own, contractions that are both less likely to achieve the goal of progressive labor and that put more stress over a longer time on the uterine scar.

I have two studies looking at VBAC after 40 weeks gestation. They agree that the risk of scar rupture is not increased for women laboring spontaneously. One study found that increasing pregnancy duration decreased the likelihood of VBAC (Coassolo 2005) while the other did not (Zelop 2001). This may have to do with the participating obstetricians' beliefs about the effect of pregnancy duration than anything intrinsic to the woman. It is probably not coincidental that the earlier study, done in a time period when obs were more relaxed about VBAC, was the one finding that longer duration did not make a difference. 

Coassolo KM, Stamilio DM, Pare E, et al. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Obstet Gynecol 2005;106(4):700-6.

Zelop CM, Shipp TD, Cohen A, et al. Trial of labor after 40 weeks' gestation in women with prior cesarean. Obstet Gynecol 2001;97(3):391-3.

-- Henci

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