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J Obstet Gynaecol Can. 2003 Apr;25(4):300-10.

The management of VBAC at term: a survey of Canadian obstetricians.

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  • 1Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada.



To determine the current practice patterns of Canadian obstetricians towards pregnant women at term, with intact membranes, who have had a previous Caesarean delivery.


A questionnaire was developed in French and English, pretested, and mailed to all obstetricians registered with the Canadian Medical Directory. Two reminders were sent out at 3-week intervals. Respondents identities were kept anonymous.


Of 1497 questionnaires sent out, 750 (50%) were returned. Of these 750 respondents, 102 were no longer working in obstetrics and 47 did not manage women with prior uterine incisions in labour, thus leaving 601 respondents (80% of all respondents) who did manage pregnant women in labour with previous Caesarean scars eligible for the analysis. Whereas 91% of these 601 respondents always counsel prospective vaginal birth after Caesarean (VBAC) candidates regarding the risk of uterine rupture, 9% never, or only occasionally, do so. Of these 601 respondents, 16% would use ultrasound assessment of lower uterine segment thickness to consider patients for VBAC, and 25% percent would use prostaglandins to induce labour in women who have had a previous Caesarean.


There is considerable disparity in the approach of Canadian obstetricians to the management of women with a previous Caesarean delivery scar who come to term without the spontaneous onset of labour, including appropriateness of inducing labour. A large, multicentre, prospective, randomized controlled trial of large numbers of women would help to determine the safety of VBAC and induction of labour in the setting of a uterine scar.

[PubMed - indexed for MEDLINE]
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