Page 19 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

percent. However, as there is not an accurate method to
38
determine which patients undergoing a TOLAC will experience
a uterine rupture, even a low risk must be considered serious.
39

Because of the lack of an accurate method to determine

whether a woman will experience uterine rupture, candidates
for TOLAC/VBAC must be chosen very carefully to minimize as

much as possible any negative outcomes to both mother and
baby. Rupture or dehiscence of a previous uterine scar can be

life-threatening for both the mother and baby. Even though
40
the odds are in favor of a successful VBAC, injuries alleged in

claims involving uterine rupture following TOLAC are potentially
very high in severity. As injuries can include massive maternal

hemorrhage with an accompanying hysterectomy, fetal demise,
or permanent asphyxial injury to the infant, a successful claim

can result in a large damages award.

Risks of liability may be mitigated by a careful selection of

candidates for TOLAC/VBAC. Standard-of-care issues can
arise when patient selection is faulty. Candidates who have

experienced the following may be at high risk for problems
during TOLAC/VBAC:

• Previous classical cesarean or inverted T uterine incision

• Previous uterine rupture

• Previous transfundal surgery

• Contraindicated vaginal delivery, e.g., placenta previa
41

38 https://vbacfacts.com/wp-content/uploads/2018/05/ACOG-PB184-VBAC-2017.pdf
39 https://www.obgproject.com/2017/08/09/candidate-vaginal-birth-cesarean-section/
40 https://www.vbac.com/what-is-a-uterine-rupture-and-how-often-does-it-occur/#.
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41 https://www.mayoclinic.org/tests-procedures/vbac/in-depth/vbac/art-20044869

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