After a prior cesarean, a VBAC is considered safe in most cases, with rare exclusions. Which is a rare exclusion?

After a prior cesarean, a VBAC is considered safe in most cases, with rare exclusions. Which is a rare exclusion?

• A. Placenta previa
• B. Inverted T incision with prior pregnancy
• C. Heart disease
• D. Shortness of breath

Answer: (D)

The concept being tested is that vaginal birth after cesarean (VBAC) is generally feasible for most women with a prior cesarean, but there are a few rare situations where attempting VBAC would be unsafe. The strongest, clear rare exclusions are related to the uterus itself or the placenta: a prior classical vertical incision or an inverted T incision in the uterus markedly increases the risk of uterine rupture, making VBAC contraindicated; placenta previa is another obstetric scenario where vaginal delivery is typically not performed. Shortness of breath, on the other hand, does not by itself automatically rule out VBAC. It signals a need to evaluate cardiopulmonary status, and only significant or decompensated disease would steer away from attempting VBAC. So shortness of breath is not an automatic or common exclusion, whereas the other factors are more direct contraindications.

The concept being tested is that vaginal birth after cesarean (VBAC) is generally feasible for most women with a prior cesarean, but there are a few rare situations where attempting VBAC would be unsafe. The strongest, clear rare exclusions are related to the uterus itself or the placenta: a prior classical vertical incision or an inverted T incision in the uterus markedly increases the risk of uterine rupture, making VBAC contraindicated; placenta previa is another obstetric scenario where vaginal delivery is typically not performed. Shortness of breath, on the other hand, does not by itself automatically rule out VBAC. It signals a need to evaluate cardiopulmonary status, and only significant or decompensated disease would steer away from attempting VBAC. So shortness of breath is not an automatic or common exclusion, whereas the other factors are more direct contraindications.