Recent data enable more-specific recommendations for managing pregnant patients who have experienced previous cesarean delivery.
Based on recent observational data as well as the outcomes of a 2010 NIH consensus conference on trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC), the American College of Obstetricians and Gynecologists (ACOG) has updated its 2004 recommendations. Although some recommendations remain unchanged (e.g., women with single prior low-transverse uterine incisions are candidates for TOLAC), the new guidelines identify additional categories of women for whom TOLAC can be considered safe. Particular emphasis is placed on antepartum predictors of successful VBAC, as risks to maternal and neonatal wellbeing are highest in the setting of failed TOLAC.
Highlights of the new guidelines include the following: