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Vaginal Birth After Cesarean
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14. A C O G Resources
What is the latest A.C.O.G. statement on this?
Vaginal birth after previous cesarean delivery
ACOG Practice Bulletin No. 54
Summary of Recommendations
The following recommendations are based on good and consistent scientific evidence (Level A):
- Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.
- Epidural anesthesia may be used for VBAC.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged. /li>
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.
- After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.
- Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery
Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 54. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;104:203-12.
Induction of labor for vaginal birth after cesarean delivery. ACOG Committee Opinion No. 271
ABSTRACT: A recent population-based study of vaginal birth after cesarean delivery (VBAC) attempts observed uterine rupture rates of 24.5 per 1,000 with prostaglandin-induced labor, while the uterine rupture rates with spontaneous labor and labor induced without prostaglandins were lower (5.2/1,000 and 7.7/1,000 respectively). The authors did not confirm the diagnoses by examining individual medical records, so the actual incidence of uterine rupture may have been overstated. Despite this limitation, the Committee on Obstetric Practice concludes that the risk of uterine rupture during VBAC attempts is substantially increased with the use of various prostaglandin cervical ripening agents for the induction of labor, and their use for this purpose is discouraged.
American College of Obstetricians and Gynecologists. Induction of labor for vaginal birth after cesarean delivery. ACOG Committee Opinion No. 271. Washington, DC: American College of Obstetricians and Gynecologists; 2002.
Non-ACOG membersNon-ACOG members
Evaluation for Cesarean Delivery (2000)
This report, developed by the ACOG Task Force on Cesarean Delivery Rates, provides approaches for ob/gyns and institutions to evaluate and, if appropriate, reduce their cesarean delivery rates.
ACOG Members (P D F )
Guidelines for Perinatal Care
American Academy of Pediatrics. American College of Obstetricians and Gynecologists Guidelines for Perinatal Care. 5th ed. Washington, D.C.: American College of Obstetricians and Gynecologists; 2002.
* ACOG Evidence grading system
The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and October 2000. The search was restricted to articles published in the English language. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document.
Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetrician-gynecologists were used. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:
- I Evidence: obtained from at least one properly designed randomized controlled trial.
- II -1 Evidence obtained from well-designed controlled trials without randomization.
- II -2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
- I I-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
- III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
- Level A-Recommendations are based on good and consistent scientific evidence.
- Level B-Recommendations are based on limited or inconsistent scientific evidence.
- Level C-Recommendations are based primarily on consensus and expert opinion.
