The percentage of women giving birth every year with a previous cesarean has tripled since 1980, when the estimated rate of births to women with a previous cesarean was 184,000, or 5.5 percent of all births.(1,2) Although the American College of Obstetricians and Gynecologists (ACOG’s) guidelines changed in 2017 (updated in 2019) in an effort to make vaginal birth after previous cesarean (VBAC) more accessible to women and to lessen facility-level barriers to making the option of VBAC routinely available (3), the variation among states of both a) percentages of women with prior cesarean births, and b) VBAC rates, indicates a lack of standardization of policies and protocols related to the care provided to this subpopulation. Patients with a previous cesarean are at an increased risk of obstetric hemorrhage, and both the rates of obstetric hemorrhage and Placenta Accreta Spectrum disorders have risen parallel to the overall cesarean birth rate.(4) This increase has generated the need for accreta centers, or high acuity facilities with blood services that include massive transfusion capabilities, and which are staffed with a multidisciplinary team of specialists to treat the growing number of complex PAS cases.
Placek, PJ, Taffel, SM. Vaginal birth after cesarean (VBAC) in the 1980s. American journal of public health vol. 78,5: 512-5. 1988.
Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2018. NCHS Data Brief, no 346. Hyattsville, MD: National Center for Health Statistics. 2019.
Vaginal birth after cesarean delivery. ACOG Practice Bulletin No. 205. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e110–27.
Placenta Accreta Spectrum. Obstetric Care Consensus No. 7. American College of Obstetricians nad Gynecologists. Obstet Gynecol 2018; 132:e259-75.