A patient who is a 2-1-0-0-1 at 34 weeks' gestation is interested in a vaginal birth after cesarean section (VBAC) and asks the nurse about this possibility
Which reason for her primary cesarean section would indicate to the nurse that the patient should be discouraged from pursuing this option?
a. Transverse lie
b. Prolapsed cord
c. Placenta previa
d. Cephalopelvic disproportion (CPD)
ANS: D
A prior cesarean birth alone is not an indication for another cesarean birth for most women. Many women will choose repeat cesarean rather than a trial of labor even if they are appropriate candidates for VBAC because of the small, but real, added risk for uterine rupture. For other women, trying to deliver their next baby vaginally—whether successful or not—is important to them. Cephalopelvic disproportion is a condition in which fetal size exceeds the size of the pelvis. In cases of true CPD, the probability of the second fetus being smaller is slim and a repeat cesarean section is warranted. The remaining indications for the primary cesarean section do not relate to fetal size and a VBAC may be considered.
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