Medical Archive

Introduction

100 years of controversy

Influencing factors

Delivery route risks

Maternal risks

• Uterine rupture
  • Low transverse ?? ? ?? ?
  • Prior C-sec? ?? ? risk factor
  • No specific pattern, little pain ? ?? ???. ??? fetal HR? ? ??
  • Maternal hypovolemia, fetal distress? ?? ????.
  • Pelvic exam?? loss of station of fetal presenting part
• Uterine infection
• Term HIE

Fetal and neonatal risks

Candidates for trial of labor

Prior uterine incision

Prior Uterine Rupture

Interdelivery Interval

Prior Vaginal Delivery

Prior Cesarean Delivery Indication

• Vaginal birth after cesarian section (VBAC)
  • ??? low transverse incision?? c/s ? ?? (2???)
  • ?? classic c/s? ???? ???? ??? ?? ??.

Fetal Size and Lie

Multifetal Gestation

Maternal Obesity

Fetal Death

Labor and delivery considerations

Timing

?? ???? 30?? Doppler? ??	30?
??/?? ?-hCG test (+) ??	36?
?? 20? ?? US? ???? ?? ? ??	??/??? ?? > 39?

Intrapartum Care

Cervical Ripening and Labor Stimulation

Epidural Analgesia

Uterine Scar Exploration

Uterine scar rupture

Diagnosis

Decision-to-Delivery Time

Management

Multiple repeat cesarean deliveries

Vaginal birth after cesarean – 2017