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TOLAC SEMINAR

obejctives <br>Definition <br>Candidates for Trial of Labor<br>Contraindications for TOLAC<br>Success Rates for Trial of Labor (TOL)<br>Labor curve for TOLAC<br>Sings of uterine rupture during TOLAC<br>Counseling a woman for TOLAC

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TOLAC SEMINAR

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  1. DEBERETABOR COLLAGE OF HEALTH SCIENCE DEPARTMENT OF MIDWIFERY Topic :TOLAC Seminar Presentation Name ID BY:- Meselu Tamir .................................1122 Moderater:- Dr (MD+, Assistant professor in OBGYN) JANUARY 9 2024, DEBRETABOR ETHIOPIA By :-Meselu.T C/M

  2. TOLAC By :-Meselu.T C/M

  3. Out Line By :-Meselu.T C/M

  4. objectives 1. Benefts and Risks (TOLAC Vs ERCS) 2. Enumerate Complications Of RECS 3.review the historical course of VBAC 4.How to counsel patient rgardining risks of TOLAC and likehood of succes 5.labour Mgt of TOLAC and its complication 6. List the indications and complicaitons of TOLACdelivery 7. Outline Success Rates for Trial of Labor (TOL) 8. Summarize prerequistes, indicators of success,CI, When to declare failed TOLACfor TOLAC 9. Preventing the need for a TOL By :-Meselu.T C/M

  5. DEFINITION Trial of labor after cesarean section (TOLAC) By :-Meselu.T C/M

  6. BENEFITS AND RISKS (TOLAC Vs ERCS) TOLAC Benefits: High success rate ( 60 to 80%). By :-Meselu.T C/M

  7. Benefits Cont’d VBAC By :-Meselu.T C/M

  8. Benefits Cont’d By :-Meselu.T C/M

  9. Benefits Cont’d By :-Meselu.T C/M

  10. Benefits Cont’d By :-Meselu.T C/M

  11. Table 1. Composite Maternal Risks from Elective Repeat Cesarean Delivery and Trial of Labor After Previous Cesarean Delivery Maternal Risks ERCD (%) TOLAC (%) One CD Two or more CDs Endometritis 1.5–2.1 2.9 3.1 Operative injury 0.42–.6 0.4 0.4 Blood transfusion 1–1.4 0.7–1.7 3.2 Hysterectomy 0–0.4 0.2–0.5 0.6 Uterine rupture 0.4–0.5 0.7–0.9 0.9–1.8 Maternal death 0.02–0.04 0.02 0 By :-Meselu.T C/M

  12. Risk of placnta accreta syndrome By :-Meselu.T C/M

  13. Risk of placnta accreta syndrome By :-Meselu.T C/M

  14. Risk of placnta accreta syndrome With no current PP With current PP By :-Meselu.T C/M

  15. BENEFITS AND RISKS (TOLAC Vs ERCS) Risks: By :-Meselu.T C/M

  16. Risk of TOLAC VS ERCS Table 2. Composite Neonatal Morbidity from Elective Repeat Cesarean Delivery and Trial of Labor After Previous Cesarean Delivery By :-Meselu.T C/M

  17. Risk of Rupture of uterus By :-Meselu.T C/M

  18. BENEFITS AND RISKS (TOLAC Vs ERCS) Elective repeat caesarian section (ERCS) By :-Meselu.T C/M

  19. By :-Meselu.T C/M

  20. BENEFITS AND RISKS (TOLAC Vs ERCS)  Risks: By :-Meselu.T C/M

  21. Candidates for Trial of Labor The following are selection criteria suggested by ACOG for identifying candidates for VBAC: By :-Meselu.T C/M

  22. Contiued for Trial of Labor By :-Meselu.T C/M

  23. Candidates cont’d By :-Meselu.T C/M

  24. Contraindications for TOLAC By :-Meselu.T C/M

  25. Contraindications for TOLAC By :-Meselu.T C/M

  26. Contraindications for TOLAC By :-Meselu.T C/M

  27. Success Rates for Trial of Labor (TOL) VBAC SUCCESS (%) Prior Indication By :-Meselu.T C/M

  28. Factors that favor success By :-Meselu.T C/M

  29. Factors that negatively influence success of VBAC By :-Meselu.T C/M

  30. Factors that negatively influence cont’d By :-Meselu.T C/M

  31. Labor curve for TOLAC By :-Meselu.T C/M

  32. Sings of uterine rupture during TOLAC By :-Meselu.T C/M

  33. By :-Meselu.T C/M

  34. Counseling a woman for TOLAC By :-Meselu.T C/M

  35. MANAGEMENT OF LABOR AND DELIVERY FOR VBAC-TOL By :-Meselu.T C/M

  36. Counseling a woman for TOLAC By :-Meselu.T C/M

  37. Antenatal management cont’d 4. Early detection of other obstetric (esp. placenta previa, PIH etc.) and medical complications (anemia etc). 5. All routine investigations to be done 6. If VBAC is to be considered, rule out the following: • Malpresentations • Multiple pregnancy • Macrosomia 7. Ultrasound: By :-Meselu.T C/M

  38. Antenatal management cont’d 8. In 3rd trimester: at every visit, enquire about: By :-Meselu.T C/M

  39. Antenatal management cont’d 9. For TOL → pelvic assessment at 37 weeks and again in early labor 10. Proper counseling for risks and benefits 11. Patients staying far → admit at 38 weeks 12. Spontaneous labor has high success rates 13. Trial of labor, should not be attempted if hemoglobin is ≤ 9 gm% or blood is not arranged (correction of anemia is very important) By :-Meselu.T C/M

  40. Antenatal management cont’d 14. Induction of labor (IOL) → not a contraindication but the risks should be explained: • Risk of uterine rupture is increased 2-3 fold • Likelihood of repeat cesarean section with IOL -1.5 fold • Misoprostol should NOT be used in 3rd trimester for cervical ripening or labor induction in cases of previous LSCS By :-Meselu.T C/M

  41. Antenatal management cont’d 15. Written and informed consent (all risks and benefits) Risks • Uterine rupture • Shock • Need for blood transfusion • Operative delivery →↑ chances of surgical injury • In adverse circumstances, hysterectomy By :-Meselu.T C/M

  42. Antenatal management cont’d • Increased fetal morbidity and in few cases mortality • Increased rate of admission to NICU • Long separation of mother and baby • Delayed resumption of breastfeeding • Risk of postoperative infection • Longer hospital stay By :-Meselu.T C/M

  43. Antenatal management cont’d 16. Proper counseling and consent for sterilization (if appropriate at that time). NOTE: Mothers should be instructed to come to hospital at onset of labor or if labor does not start after 41 weeks of gestation or if any complications arise without delay. By :-Meselu.T C/M

  44. Assessment of Scar Integrity By :-Meselu.T C/M

  45. Assessment cont’d By :-Meselu.T C/M

  46. Assessment cont’d By :-Meselu.T C/M

  47. Assessment cont’d By :-Meselu.T C/M

  48. MANAGEMENT IN LABOR Delivery → always where facility for emergency cesarean section is present. 1st stage Latent phase: By :-Meselu.T C/M

  49. MANAGEMENT IN LABOR cont’d By :-Meselu.T C/M

  50. Active 1st stage cont’d 1. Blood group and cross match 2. Patient kept NPO or on a liquid diet 3. IV line secured 4. Anesthetist and neonatologist kept informed 5. Monitoring done meticulously: • FHS – If facilities available → CTG – If not, intermittent auscultation or use of doppler By :-Meselu.T C/M

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