Which client is the best candidate for VBAC?

Which client is the best candidate for VBAC?

• A. Dilated 6 cm last time, last labor progression
• B. Diabetic last infant over 10 lbs
• C. Emergency cesarean with classic incision
• D. Breech last pregnancy, current vertex

Answer: (D)

VBAC is most likely successful when the woman has had a prior cesarean with a low transverse uterine incision and currently presents with a cephalic (head-down) fetus, without other uterine scars or contraindications. The scenario describing a prior cesarean for breech with a current vertex presentation fits this pattern best. A breech indication in the last pregnancy does not automatically rule out VBAC if the incision was low transverse, and the head-down position now reduces complications during labor, making a trial of labor after cesarean more favorable. In contrast, an emergency cesarean with a classic (vertical) incision is a clear contraindication to VBAC due to the higher risk of uterine rupture. Diabetes with a macrosomic infant increases risk during labor but does not by itself guarantee ineligibility for VBAC if the prior scar is suitable and other factors are favorable. The option that lacks a prior cesarean history or relevant scar information is less clearly a VBAC candidate. If attempting VBAC, it should be planned in a facility equipped for rapid cesarean delivery with continuous fetal monitoring and trained personnel available.

VBAC is most likely successful when the woman has had a prior cesarean with a low transverse uterine incision and currently presents with a cephalic (head-down) fetus, without other uterine scars or contraindications. The scenario describing a prior cesarean for breech with a current vertex presentation fits this pattern best. A breech indication in the last pregnancy does not automatically rule out VBAC if the incision was low transverse, and the head-down position now reduces complications during labor, making a trial of labor after cesarean more favorable.

In contrast, an emergency cesarean with a classic (vertical) incision is a clear contraindication to VBAC due to the higher risk of uterine rupture. Diabetes with a macrosomic infant increases risk during labor but does not by itself guarantee ineligibility for VBAC if the prior scar is suitable and other factors are favorable. The option that lacks a prior cesarean history or relevant scar information is less clearly a VBAC candidate.

If attempting VBAC, it should be planned in a facility equipped for rapid cesarean delivery with continuous fetal monitoring and trained personnel available.