Trial of labour after C.section/ VBAC

1. VBAC / TOLAC

2. • VBAC – Vaginal Birth after Cesarean
• TOLAC – Trial Of Labour after Cesarean

3. What’s special about this lady
with
pr .CS
• Scar on the uterus
• Integrity
• Withstanding pregnancy( classical ) & more so
labour(LSCS)

4. Integrity of uterine scar

5. Complications of VBAC
• Uterine rupture
• Uterine dehiscence
• Hysterectomy
• Thromboembolic disease
• Blood & Blood product transfusion reactions
• Maternal Death

6. Complications to the Fetus
• Antepartum stillbirth
• Intrapartum still birth
• Term HIE
• Term neonatal death

7. Prerequisites for VBAC
• 1 pr .LSCS only
• Informed double consent
• Power - Spontaneous onset of labour
• Passage - Pelvis – adequate
• Passenger -Longitudinal lie with cephalic
presentation with vertex as presenting part
• No medical / surgical disorders complicating
pregnancy
• Team ready
• Blood & blood products availability

8. Scar Dehiscence & Rupture

9. • Complete rupture – all the layers involved
•
• Incomplete rupture / Scar Dehiscence – only
the muscle layer involved with intact visceral
peritoneum

10. Features os scar dehiscence