Information in the old stickies?

[Monkey Keeper]

I'm looking for some good information for a friend whose OBs told her that VBA2C would result in a catastrophic outcome (grrrrr...so much for INFORMED CONSENT). And I can't find the stupid Wikis.  Help a mama out?  THANKS!

[crystal_buffaloe]

Where are the old stickies?

[GoddessKristie]

I don't know about the stickies, but here are the most current ACOG recomendations:http://www.medscape.com/viewarticle/725597

Quote:

The practice bulletin makes the following specific recommendations based on good, consistent scientific evidence (level A):

• TOLAC may be appropriate for most women with 1 previous cesarean delivery via a low transverse incision. These women should be counseled about VBAC and offered TOLAC as a delivery option.
• As part of TOLAC, epidural analgesia may be used for labor.
• For women who have undergone previous cesarean delivery or major uterine surgery, misoprostol should not be used for third-trimester cervical ripening or labor induction.

Also included in the statement are the following recommendations based on limited or inconsistent scientific evidence (level B):

• TOLAC may be considered in women with 2 previous low transverse cesarean deliveries.
• TOLAC may be considered in women with 1 previous cesarean delivery via a low transverse incision who are otherwise appropriate candidates for twin vaginal delivery.
• In women with a previous cesarean delivery via a low transverse uterine incision who are at low risk for adverse maternal or neonatal outcomes from external cephalic version and TOLAC, external cephalic version for breech presentation is not contraindicated.
• Planned TOLAC is generally not recommended in women at high risk for complications, such as those with a classic or T-incision; prior uterine rupture; extensive transfundal uterine surgery; and in other women in whom vaginal delivery is contraindicated, such as those with placenta previa.
• In women undergoing TOLAC, it is permissible to induce labor, when appropriate, based on maternal or fetal indications.
• For women with previous cesarean delivery with an unknown uterine scar type, TOLAC is not contraindicated unless there is a high clinical suspicion for a previous classic uterine incision.

Finally, the statement also provides the following recommendations that are based mainly on consensus and expert opinion (level C):

• Women undergoing TOLAC should do so at facilities able to perform emergency deliveries and with staff immediately available to provide emergency care because of unpredictable risks associated with TOLAC.
• When these resources are not available, women should be clearly advised regarding greater risks for TOLAC and management alternatives, and counseling and management plans should be documented in the medical record.