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  #1  
Old 11-20-2012
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Default VBAC vs CS

38-year-old, G2P0, Spanish-speaking woman at 36 weeks’ gestation is seen in the antepartum evaluation center with contractions and concerns that her water broke. Her nephew reports that roughly 20 years ago, while living in Nicaragua, she required an emergency cesarean section for unknown reasons. On examination, she appears in no acute distress. Her heart rate is 80/min, and her blood pressure is 110/60 mm Hg. Tocometry reveals uterine contractions lasting 30 seconds. An abdominal sonogram reveals a fetus that is of appropriate size for gestational age and is in vertex position. Fetal heart tracing is reassuring. What is the best next step in management?

(A) Administer tocolysis
(B) Augment with oxytocin
(C) Cesarean section
(D) Emergent cesarean section
(E) Manage expectantly and anticipate spontaneousvaginal delivery
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  #2  
Old 11-20-2012
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Quote:
Originally Posted by heartbeat View Post
38-year-old, G2P0, Spanish-speaking woman at 36 weeks’ gestation is seen in the antepartum evaluation center with contractions and concerns that her water broke. Her nephew reports that roughly 20 years ago, while living in Nicaragua, she required an emergency cesarean section for unknown reasons. On examination, she appears in no acute distress. Her heart rate is 80/min, and her blood pressure is 110/60 mm Hg. Tocometry reveals uterine contractions lasting 30 seconds. An abdominal sonogram reveals a fetus that is of appropriate size for gestational age and is in vertex position. Fetal heart tracing is reassuring. What is the best next step in management?

(A) Administer tocolysis
(B) Augment with oxytocin
(C) Cesarean section
(D) Emergent cesarean section
(E) Manage expectantly and anticipate spontaneousvaginal delivery
Hmm. I would assume VBAC would be OK if it was a Lower segment incision. But not a classic uterine incision. Since that is not specified, and given she is from a country that I have never heard of (:P) I would assume it was a Classic Incision.

So I would say "C" Cesarean section (Not emergent since both are stable)

Is there a way vial USG or CT to know what the previous incision was ? Or does the normal Uterine contractions indicate that the uterus is stable enough ? Would love to hear the explanation.
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Default Interesting

Hmm...interesting question..but i will go with E .
Although she comes from a country in the americas , i dont think its enough info to assume that she has had a classical incision.
I recommend a trial of labor with a cs if things go awry.
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(C) Cesarean section

Emergency cesarean section 20 yrs ago in Nicaragua-most likely a classical c- section. I am not taking any chances.
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Quote:
Originally Posted by flukologist View Post
Hmm...interesting question..but i will go with E .
Although she comes from a country in the americas , i dont think its enough info to assume that she has had a classical incision.
I recommend a trial of labor with a cs if things go awry.
Hmm. Waiting for a Uterine Rupture I don't think would be wise. But who knows. Maybe A.Tocolysis and ask for previous records ? Just thought of that.
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she is not in distress and neither is the baby. so i would go with E with close observation ofcourse.
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Default (E) Manage expectantly and anticipate spontaneousvaginal delivery

(E) Manage expectantly and anticipate spontaneousvaginal delivery
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VBAC is only done with h/o prior lower segment c-section.

C-section is always done with h/o prior classical c-section.
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  #9  
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The correct answer is C. In this case, there is not enough information to proceed safely with a vaginal delivery. The cesarean section was emergent and is thus more likely to have involved a midline incision.
Quote:
Originally Posted by Nik7733 View Post
Hmm. I would assume VBAC would be OK if it was a Lower segment incision. But not a classic uterine incision. Since that is not specified, and given she is from a country that I have never heard of (:P) I would assume it was a Classic Incision.

So I would say "C" Cesarean section (Not emergent since both are stable)
Quote:
Originally Posted by Novobiocin View Post
(C) Cesarean section

Emergency cesarean section 20 yrs ago in Nicaragua-most likely a classical c- section. I am not taking any chances.
Quote:
Originally Posted by Novobiocin View Post
VBAC is only done with h/o prior lower segment c-section.

C-section is always done with h/o prior classical c-section.
Good explanations
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