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TOLAC (trial of labor after cesarean)


TOLAC is a term that replaced VBAC (vaginal birth after cesarean) in medical use, acknowledging that not every attempt to deliver vaginally after cesarean is successful, although the rate can be as high as 75%. Essentially the outcome may be approximated from before. Assuming for example the initial cesarean was indicated by a disproportion between fetal size and maternal pelvis and current ultrasound estimations of weight exceed the ones of the anterior gestation, it makes sense not to attempt a TOLAC. On the other hand if previous cesarean was performed because of breech (feet first) presentation of the baby, a TOLAC may be reasonable. The risks with TOLAC recur mainly from the weakness of previous uterine scar and the management should always be guided by a continuous assessment of risks/benefits balance, keeping in mind the possibility of uterine rupture during the labor, which may endanger seriously both fetal and maternal life.

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