Obstetrics & Gynecology>>>>>Antepartum Care and Fetal Surveillance
Question 4#

The patient wants to know about the probability of success if she chooses to undergo TOLAC.

What can you tell her about factors that impact the probability of success in TOLAC?

a. The probability of successful TOLAC is increased for her because she is Hispanic
b. She is likely to have a successful TOLAC because she has never had a vaginal delivery
c. Her weight does not impact her chance for successful TOLAC
d. Her age does not impact her chance for successful TOLAC
e. If she goes into labor spontaneously before 40 weeks, her chance for successful TOLAC will be increased

Correct Answer is E

Comment:

Good candidates for TOLAC are women in whom the balance of risks and benefits are acceptable to the patient and health care provider. Decisions regarding TOLAC must be made on an individual basis while taking these factors into account. Most evidence suggests that most women with one prior low transverse cesarean should be counseled about vaginal birth after cesarean (VBAC) and offered TOLAC. Factors that increase the probability of success include prior vaginal delivery and spontaneous labor. Factors that predict a decreased probability of success include increased maternal age, Hispanic or African American ethnicity, postdates gestation, and maternal obesity. Therefore, spontaneous labor prior to 40 weeks would provide this patient with the greatest chance of successful TOLAC.