Improving Chances of a Successful VBAC
  • Baby is in the Vertex (Head Down) Position
    • Breech Presentation is Contraindicated
    • Malposition increases risk of failure
  • Baby Weight less than 4500 grams
  • High Bishop Score
    • Favorable cervix
    • Increased success if cervix 75-90% effaced
  • Hospital
    • Increased success in Public vs. Private Hospital
  • Maternal Body Mass Index (BMI) less than 30 kg/m2
  • Maternal Height (Above average)
  • Maternal Education
    • Increased success with greater than 12 years of education
  • No underlining Maternal Medical conditions that make the patient High-Risk
    • Advanced Maternal Age (AMA)
    • Diabetes
    • Hypertension, Preeclampsia, Eclampsia
  • Only 1 previous C/S and no more than 2 previous C/S
    • Risk of Uterine Rupture is 0.2%-0.9% with 1 Previous C/S
    • Risk of Uterine Rupture is 2% with 2 Previous C/S
    • Risk of Uterine Rupture is 3% with 3 Previous C/S
    • Risk of Uterine Rupture is 10-12% with >3 Previous C/S
  • Pregnancy carrying only (1) Baby
    • Twins increase risk of failure
    • Triplets and Increasing Multiples further increase risk of failure and is not recommended
  • Previous Lower Segment Transverse C/S (LSTCS)
    • Risk of Uterine Rupture is 10-11.5% with a Classical C/S
      • 0.64% with scheduled ERCS
      • 11.5% with unplanned TOLAC
    • Increased Risk of Uterine Rupture with Low Vertical Incision (1.1%), T-shaped, Inverted T-shaped, or J-shaped incision.
  • Previous Successful VBAC
    • 60-74% probability with no previous VBAC
    • 90% probability of success with a previous VBAC
    • 0.1-0.5% Risk of Uterine Rupture
  • Race
    • Increased success with Non-Hispanic White
    • Decreased success with Hispanic and Black Race
  • Spontaneous Labor less than 40 weeks of Gestational Age
    • Increased Risk of failure with spontaneous labor or induction of labor greater than 40 weeks of gestational age
  • Spontaneous Labor compared to Induction of Labor
    • 60-74% success rate with spontaneous labor
    • 63% success rate with induction of labor
    • 54% with Transcervical Balloon
    • 2% Risk of Uterine Rupture with Oxytocin Induction
    • 5-15% Risk of Uterine Rupture with Cytotec/Misoprostol Induction
  • The chances of a successful VBAC increases when the medical situation that lead to the previous C/S or failed TOLAC is not repeated in the current TOLAC.
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