Vaginal birth after cesarean (VBAC) Quiz: Ace Your Exams

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A 29-year-old woman, gravida 3, para 2, at 35 weeks of gestational age, presents to discuss her mode of delivery. Her pregnancy has been uncomplicated, and she has no concerns today. Her first cesarean birth was performed for arrest of dilation at 7 cm and complicated by postpartum endomyometritis. During her second pregnancy, she had an anterior placenta previa and underwent a repeat cesarean birth that was then complicated by a postpartum hemorrhage requiring a blood transfusion. Vital signs are within normal limits. Physical exam is unremarkable with a normal fundal height. Obstetric ultrasound shows an anterior placenta 25 mm from the internal cervical os, a single deepest vertical pocket of 2.4 cm, and a single viable fetus in the vertex presentation with a fetal heart rate of 150 bpm. Which of the following is the best reason to recommend a planned repeat cesarean birth (PRCB) over a trial of labor after cesarean (TOLAC) for this patient?

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VBAC would be associated with higher rates of postpartum endomyometritis than PRCB.

VBAC would be associated with higher rates of postpartum hemorrhage than PRCB.

Decreased chance of successful VBAC

She is at increased risk for abnormal placentation in future pregnancies

She is at increased risk for uterine rupture with TOLAC