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VBAC Calculator

Estimates probability of successful vaginal birth after cesarean (TOLAC success)

Indication

  • Estimates probability of successful vaginal birth after cesarean (TOLAC success)

Criteria

  • id: prior_vaginal; label: Prior vaginal delivery (including prior VBAC); type: yesno
  • id: recurring_indication; label: Recurring indication for prior cesarean (e.g., CPD, FTP); type: yesno
  • id: age_under_35; label: Age < 35; type: yesno
  • id: bmi_under_30; label: BMI < 30; type: yesno
  • id: favorable_cervix; label: Favorable cervical exam at admission (dilated, effaced); type: yesno
  • id: spontaneous_labor; label: Spontaneous labor (not induced); type: yesno

Interpretation

  • function(score) { if (score >= 5) return { risk: score + '/6 favorable factors', tier: 'High Probability of VBAC Success', action: 'Estimated VBAC success >75%. TOLAC reasonable with appropriate counseling and monitoring. Continuous EFM required.', color: 'green' }; if (score >= 3) return { risk: score + '/6 favorable factors', tier: 'Moderate Probability', action: 'Estimated VBAC success ~60-75%. Shared decision-making. Ensure surgical team immediately available.', color: 'yellow' }; return { risk: score + '/6 favorable factors', tier: 'Lower Probability', action: 'Estimated VBAC success <60%. Discuss risks/benefits thoroughly. Elective repeat cesarean is reasonable alternative.', color: 'red' }; }

Clinical pearls

  • Overall TOLAC success rate is ~60-80%
  • Uterine rupture risk with TOLAC: ~0.5-0.7% (low transverse scar)
  • Prior vaginal delivery is the strongest predictor of VBAC success
  • TOLAC is contraindicated with prior classical (vertical) uterine incision

Source and review

  • Grobman et al., Obstet Gynecol 2007 (MFMU Network). Last reviewed: 2024-11-01