A. assesment started by taking obstetric hx including prev. VBAC as associated with highest succes rate ,indication of prev. C.S. and time intrval sinceit as thiswill affect succes rate,prev.c.s. for dystocia and cx dil. below 4cm at time of prev.c.s. associated with lower succes rate,Medicalhx to asses fitness for surgery and anaesthesia ,ex. started by general ex. p.bp. as hypotensio ,n and tachycardia sign of dehisence, ht,wt,BMI >30 lower succes,local abd. ex. for size of baby confirm presentation and how many fifth of fetal head palpable abd. ,vag. ex. to asses cx dil colour of liq. presence of caput or moulding to R.O. CPD CTG, evaluated as deceleration repeated variable or prolonged bradycardia associated with dehescence,assesadequacy and regularity of contraction.
B.the pt. should be managed in fully equiped delivery suite ,consultant obstetrician and anaesthetist shoud be alerted early ,blood bank informed blood sent for group and save or x-matched acc. to clinical situation in case of any emergency arised ,dept shoud be able to offer em.C.S. when the need arise withadequate N.N. facility,therae shoud be cont. monitoring of fhr and uterine contraction and maternal monitoring ,p. b.p. O2 sat.OPTION of MGT to be D.W.woman by consultant obstet.,if there is sign ofcpd or path CTG. emergency C.S. offered to her,if fetal size average and contraction not adequate fetal hert normal woman offered augmentation by oxytocin benefit by an of bringing labour forwrd discussed and risks of increasing incidence of uterine rupture ,or awaiting acouple of hour under cont, maternal and fetal monitor to document failure of progress of lab. and doing c.s. incase of arrest of cx dil. the maternal wish for her mode of delivery shoud be respected.
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