Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care
CPT4 code
Name of the Procedure:
Cesarean Delivery Only, Following Attempted Vaginal Delivery After Previous Cesarean Delivery (Commonly referred to as "C-Section after TOLAC" or "Repeat Cesarean after Failed VBAC")
Summary
A Cesarean delivery, often known as a C-section, is a surgical procedure in which a baby is delivered through an incision made in the mother's abdomen and uterus. This specific procedure is performed when a vaginal birth attempt after a previous C-section (Trial of Labor After Cesarean, TOLAC) is unsuccessful.
Purpose
This procedure addresses situations where a vaginal delivery (VBAC - Vaginal Birth After Cesarean) is attempted but complications arise that necessitate a surgical birth. The goal is to ensure the safe delivery of the baby and the health of the mother.
Indications
- Failure to progress in labor.
- Fetal distress.
- Uterine rupture or risk thereof.
- Maternal medical conditions that necessitate a quick delivery.
Preparation
- Patients may be instructed to fast for 8 hours before the surgery.
- Preoperative blood tests.
- IV line insertion for medications and fluids.
- Discussion of the risks and benefits of the procedure with the healthcare team.
Procedure Description
- Preparation: The patient is brought to the operating room and given regional (epidural or spinal) anesthesia to numb the lower body, or general anesthesia if necessary.
- Incision: An incision is made in the lower abdomen, usually horizontally just above the pubic hairline.
- Delivery: The surgeon makes a second incision in the uterus. The baby is then delivered through these incisions.
- Placenta Removal: After the baby is delivered, the placenta is removed from the uterus.
- Closure: The uterine incision is stitched up, followed by the abdominal incision.
Duration
The procedure typically takes around 45 to 60 minutes.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Obstetrician/Surgeon
- Anesthesiologist
- Surgical nurses
- Pediatrician or neonatal specialist (for the baby)
Risks and Complications
- Infection.
- Blood loss and need for transfusion.
- Injury to surrounding organs.
- Blood clots.
- Adhesions and future pregnancy complications.
Benefits
- Safely delivering the baby when a vaginal birth cannot proceed.
- Reduced risk of complications associated with prolonged labor or fetal distress.
- Usually immediate realization of benefit as the baby is delivered safely.
Recovery
- Hospital stay of 3 to 4 days.
- Pain management through medication.
- Instructions for wound care.
- Avoid heavy lifting for about 6 weeks.
- Follow-up appointments to monitor healing.
Alternatives
- Reattempted vaginal delivery, though this may pose heightened risks depending on the situation.
- Elective repeat cesarean delivery before labor begins.
- The choice of alternative depends on the specifics of the patient's medical history and current situation.
Patient Experience
- During the procedure: Patient is awake with regional anesthesia, may feel pressure but no pain, or asleep under general anesthesia.
- Post-procedure: Pain and discomfort managed with medication, hospital stay for monitoring, and support with breastfeeding and newborn care.