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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Vaginal Birth After Cesarean
Sponsored by The Indian Health Service Clinical Support Center
9. A A F P vs A C O G Recommendations
ACOG vs AAFP Recommendations
A C O G
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.
A A F P
A A F P says
the following, based on evidence supplied by the Agency for Healthcare Research and Quality (AHRQ), which used a rigorous process for systematic identification, retrieval, evaluation, and analysis of all relevant research.
"TOLAC should not be restricted to maternity care facilities with available surgical teams present throughout labor, because there is no evidence that these additional resources result in improved outcomes.* [SORT rating C]
At the same time, it is clinically appropriate that a management plan for uterine rupture and other potential emergencies requiring rapid cesarean delivery should be documented for each woman undergoing TOLAC. [SORT rating C]
Maternity care professionals need to explore all issues that may affect a woman's decision (e.g., recovery time, safety). [SORT rating C]
No evidence-based recommendation can be made about the best way to present the risks and benefits of TOLAC to patients."
...so why is there a difference with A C O G?
As a symptomatic uterine rupture is an infrequent event.
and
As other obstetric emergencies combine to a higher likelihood of occurrence...
...at this point there is not data that has looked in systematic manner at the delivery of the 'low risk' VBAC patient * versus the risks of other normal vaginal delivery urgencies or emergencies.
*(Low risk VBAC: 1 prior low transverse cesarean delivery, spontaneous onset labor, no need for augmentation, no repetitive FHR abnormalities, and patients with a prior successful VBAC)
American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 54. Obstet Gynecol 2004;104:203-12.
