Question about fetal monitoring during VBAC

Phelia325 · May 2011

I can't seem to find the answer through googling and plan to ask my OB at this week's appt, but I thought you ladies would know. Can fetal monitoring detect a rupture BEFORE it happens? Or is only useful in showing that a rupture has taken place? Is there any monitoring that can detect a rupture before it occurs? TIA

chicsub · May 2011

Good question and I don't know the answer. My gut is telling me it only detects after it has started to happen, but uterine ruptures are typically not catastrophic, so you normally have time to take action if that's your concern. I'm sure somebody else knows for sure though and I'm just speculating.

BaumMom · May 2011

I asked my doctor at my last appointment about this, sorta. He said one of the ways that a rupture actually harms the baby is that if the umbilical cord slips through the hole in the uterus. When the uterus contracts, it can clamp down on the cord, in which case you will notice severe decels via fetal monitoring. So, in this case, it would seem that no, monitoring cannot predict when a rupture is occuring, but rather after it occurs, and only then if the rupture itself has somehow compromised the baby, cord or placenta.

But my doctor also assured me though, that even in the very unlikely event of a UR, it is likely that the baby will not suffer any significant impact from it.

BaumMom · May 2011

Also I'd love to hear what your doctor says when you ask him/her

Phelia325 · May 2011

BaumMom:
Also I'd love to hear what your doctor says when you ask him/her

I will definitely update on Wednesday!

iris427 · May 2011

As far as I know, there is no reliable way to predict a rupture before it happens (either during pregnancy or labor).

papagena · May 2011

iris427:
As far as I know, there is no reliable way to predict a rupture before it happens (either during pregnancy or labor).

Another vote for this. I've only ever heard of the use of EFM because it can detect early stress to baby because a UR has already occurred.

BlinkingLight1 · May 2011

I was just reading about this recently. From what I remember a certain pattern in the baby's heartrate (say, a sudden significant dip) can signal a rupture has already happened. But, the change in HR could also mean something else is going on.

I'm torn as to whether I will have continuous monitoring while at the hospital because of the possibilities of false positives.

Phelia325 · May 2011

My doc said monitoring cannot detect rupture before it occurs only helpful to detect rupture that has already occurred.

Geekchick921 · May 2011

IIRC, fetal distress as well as a cessation of contractions or an irregular contraction pattern can indicate a rupture, but I think it's like what Phelia said. It can't predict, just detect, but they could intervene before it gets worse.

The data in this article actually poses a pretty good argument to using CFM to detect a rupture (which I kind of hate to admit). https://emedicine.medscape.com/article/275854-overview#aw2aab6b6 Prolonged fetal decels or bradycardia had the highest incidence in the collection of symptoms listed, by far.

That said, I still think continuous fetal monitoring leads to way too many ultimately unnecessary C-sections, both primary and unsuccessful VBACs. My own included.

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