Review Note

Last Update: 03/27/2025 09:20 PM

Current Deck: ACG Part 2::Obstetrics

New Card (Unpublished)

No published tags.

SS_OB 1.34 Discuss the anaesthetic management of problems that may arise with labour and delivery, including the following situations:
- VBAC

Planned labour with a view to safe vaginal birth in a woman who has had a prior LSCS delivery:

Risks:
- Uterine scar rupture (5–7 per 1000 attempts).
- If rupture occurs, 1 in 7 chance of serious adverse outcomes (death or brain injury) for the baby.

Requirements for a planned VBAC:
- Conducted in a suitably staffed and equipped delivery suite.
- Continuous intrapartum care and monitoring.
- Resources must be available for urgent LSCS and advanced neonatal resuscitation if complications (e.g., uterine rupture) occur.

Major maternal morbidity:
- Uterine rupture and hysterectomy.
- Emergency LSCS if VBAC is unsuccessful.
- Pelvic floor trauma.
- Maternal death (0.02 per 1000).
- Genitourinary injury.
- Blood transfusion requirement.

Major perinatal morbidity:
- Stillbirth after 39 weeks (due to longer gestation).
- Intrapartum or neonatal death (0.4–0.7 per 1000, related to scar rupture in labour).
- Hypoxic-ischaemic encephalopathy (HIE) risk (0.7 per 1000):
  - Neurological impairment due to insufficient oxygenated blood perfusing brain tissue.
  - Manifests within the first few days after birth.
  - Associated with multi-organ damage from perfusion injury.
- Fetal acidosis.