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A VBAC question

      To the editors:

      The article by Blanchette et al
      • Blanchette H
      • Blanchette M
      • McCabe J
      • Vincent S
      Is vaginal birth after cesarean safe? Experience at a community hospital.
      proved thought provoking. Contained within were seven points that can be used as a guide toward a safe vaginal birth after prior cesarean section. These points were presented in a clear and pragmatic manner. The danger with an article that makes one think is the questions that arise in the reader's mind. One question would be, why not add pelvic assessment?
      The use of x-ray pelvimetry to assess the pelvis can be argued against by use of literature examples, such as increased cesarean section rate or fetal damage. Use of this technique either before pregnancy or just after the first cesarean section would be one way around some of these arguments. Another would be the use of the De Lee pelvimeter to measure anteroposterior diameter at the time of the first cesarean section as part of the pelvic assessment. This simple instrument does not add the risk of an x-ray technique and provides a quantitative measure that can be used to guide future decision making.

      References

        • Blanchette H
        • Blanchette M
        • McCabe J
        • Vincent S
        Is vaginal birth after cesarean safe? Experience at a community hospital.
        Am J Obstet Gynecol. 2001; 184: 1478-1487