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VBAC MCQs

When counseling patients regarding mode of delivery after a previous cesarean section, it is important to stress that a scheduled repeat cesarean carries the greatest risk of maternal morbidity. A failed trial of labor after cesarean (TOLAC) also carries higher risk than a successful TOLAC. The outcome most strongly associated with increased neonatal and maternal morbidity in a TOLAC is uterine rupture. A successful TOLAC offers advantages like lower rates of hemorrhage and shorter recovery over repeat cesarean. Without other details, a reasonable success rate to provide for TOLAC is 50-70%. Factors making a successful TOLAC less likely include a previous cesarean for non-reassuring fetal heart tones

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955 views3 pages

VBAC MCQs

When counseling patients regarding mode of delivery after a previous cesarean section, it is important to stress that a scheduled repeat cesarean carries the greatest risk of maternal morbidity. A failed trial of labor after cesarean (TOLAC) also carries higher risk than a successful TOLAC. The outcome most strongly associated with increased neonatal and maternal morbidity in a TOLAC is uterine rupture. A successful TOLAC offers advantages like lower rates of hemorrhage and shorter recovery over repeat cesarean. Without other details, a reasonable success rate to provide for TOLAC is 50-70%. Factors making a successful TOLAC less likely include a previous cesarean for non-reassuring fetal heart tones

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Hana
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© © All Rights Reserved
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VBAC

When counseling a patient, it is important to stress which of the following in regards to


maternal morbidity and mode of delivery:

A. A VBAC carries the greatest risk to maternal morbidity

B. A scheduled repeat cesarean section carries the greatest risk to maternal morbidity

C. A scheduled repeat cesarean section has a greater risk to maternal morbidity than a failed
TOLAC

D. A failed TOLAC carries the greatest risk to maternal morbidity

The outcome associated with TOLAC that most greatly increases the risk of neonatal and
maternal morbidity is:

A. Endometritis

B. Arrest of descent

C. Uterine rupture

D. Cord prolapse

E. None of the above

A successful VBAC can have several advantages for patients in comparison to a scheduled
repeat cesarean section, including:

A. Lower rates of hemorrhage

B. Shorter recovery period

C. Lower rates of infection

D. B and C

E. All of the above

A patient presents to your clinic requesting information regarding the success rates of
TOLAC. Without knowing anything about the patient, it would be reasonable to tell her that
success rate ranges between:

A. 40 and 50%

B. 50 and 70%

C. 60 and 80%

D. 70 and 90%

Which of the following factors make having a successful TOLAC LESS likely?
A. Indication for previous primary low transverse cesarean section was for non-reassuring
fetal heart tones

B. African American ethnicity

C. Short pregnancy interval

D. B and C

E. All the above

Which of the following patients should NOT be offered a TOLAC?

A. Patient with a history of an extensive abdominal myomectomy

B. Patient with a current twin gestation pregnancy

C. Patient with a history of a previous low vertical incision

A and D

All the above

A patient with a previous cesarean section of unknown scar type may still be offered a
TOLAC.

A. TRUE

B. FALSE

Studies have revealed that higher doses of oxytocin are associated with a dose-response
effect with increasing risks of uterine rupture. Due to this, the following recommendation
has been made:

A. The maximum pitocin dosage for a patient attempting TOLAC is 32 mu/min

B. Unless location of previous uterine incision is clearly documented, pitocin levels above 16
mu/ min should not be used

C. There is not enough evidence to recommend an upper limit of oxytocin dosing in patients
attempting TOLAC

D. In a patient with a history of two previous lower uterine segment incisions, pitocin is
clearly contraindicated

What is the most common sign associated with uterine rupture?

A. Fetal heart rate abnormality

B. Increased uterine contractions

C. Vaginal bleeding

D. Loss of fetal station

E. New onset intense uterine pain

In a patient attempting TOLAC, cervical ripening with a transcervical Foley catheter has been
associated with uterine rupture rates similar to spontaneous labor.
A. TRUE

B. FALSE

Your 32-year-old patient had planned for a TOLAC. She presents in spontaneous labor at
term and her fetus is estimated to be 4500 g. She has an otherwise uncomplicated
pregnancy. How do you counsel her?

A. If her fetus is macrosomic, her likelihood of a successful VBAC is lower and her risk for
uterine rupture is higher

B. If her fetus is macrosomic, her likelihood of a successful VBAC is unchanged and her risk
for uterine rupture is higher

C. If her fetus is macrosomic, her likelihood of a successful VBAC is unchanged as is her risk
for uterine rupture

D. If her fetus is macrosomic, her likelihood of a successful VBAC is lower, but her risk for
uterine rupture is unchanged

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