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- Table 1.
Executive Summary of AAFP Clinical Practice Guideline on Trial of Labor After Cesarean
The American Academy of Family Physicians Commission on Clinical Policies and Research convened a panel to systematically review the available evidence on trial of labor after cesarean (TOLAC) using the Agency for Healthcare Research and Quality “Evidence Report on Vaginal Birth After Cesarean (VBAC).” The panel’s objective was to provide an evidence-based clinical practice guideline for pregnant women and their families, maternity care professionals, facilities, and policy makers who care about trial of labor and maternity care for a woman with one previous cesarean. The recommendations are as follows: Recommendation 1: Women with 1 previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (TOL). (Level A) Recommendation 2: Patients desiring TOLAC should be counseled that their chance for a successful vaginal birth after cesarean (VBAC) is influenced by the following: (Level B) Positive factors (increased likelihood of successful VBAC) Negative factors (decreased likelihood of successful VBAC) Maternal age <40 years Increased number of previous CDs Previous vaginal delivery (particularly previous successful VBAC) Gestational age >40 weeks Favorable cervical factors Birthweight >4,000 g Presence of spontaneous labor Induction or augmentation of labor Nonrecurrent indication that was present for previous cesarean delivery (CD) Recommendation 3: Prostaglandins should not be used for cervical ripening or induction, as their use is associated with higher rates of uterine rupture and decreased rates of successful vaginal delivery. (Level B) Recommendation 4: TOLAC should not be restricted only to facilities with available surgical teams present throughout labor, because there is no evidence that these additional resources result in improved outcomes. (Level C) At the same time, it is clinically appropriate that a management plan for uterine rupture and other potential emergencies requiring rapid cesarean section should be documented for each woman undergoing TOLAC. (Level C) Recommendation 5: Maternity care professionals need to explore all the issues that may affect a woman’s decision, including issues such as recovery time and safety. (Level C) No evidence-based recommendation can be made regarding the best way to present the risks and benefits of TOLAC to patients. - Table 2.
Clinical Practice Guidelines Developed by the AAFP Either Alone or in Conjunction With Other Groups
Guideline Collaborating Group(s) AAFP Web Address * In addition to the AAFP, members of the consortium are the American Academy of Neurology, American College of Emergency Physicians, (then) ACP-American Society of Internal Medicine, American Osteopathic Association, American Headache Society, and National Headache Foundation. The Benefits and Risks of Controlling Blood Glucose Levels in Patients With Type 2 Diabetes Mellitus None http://www.aafp.org/PreBuilt/diabpol2.pdf Management of Newly Detected Atrial Fibrillation College of Physicians http://www.aafp.org/x25474.xml Migraine Headache Treatment Guidelines American U.S. Headache Consortium* http://www.aafp.org/x21710.xml The Management of Minor Closed Head Injury in Children American Academy of Pediatrics (AAP) http://www.aafp.org/x1595.xml Diagnosis and Management of Acute Otitis Media AAP http://www.aafp.org/x26481.xml Otitis Media With Effusion AAP, American Academy of Otolaryngology-Head and Neck Surgery http://www.aafp.org/x1596.xml
Additional Files
Guidelines
Trial of Labor After Cesarean (TOLAC), Formerly Trial of Labor Versus Elective Repeat Cesarean Section for the Woman With a Previous Cesarean Section. Posted as supplied by author.
Files in this Data Supplement:
- Data supplement: TOLAC Guidelines - PDF file, 20 pages, 201 KB
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