**7. VBAC predictive score**

There are several predictive tools and models to improve the outcome of VBAC which are deployed into clinical practice. However, this will not substitute careful clinical selection and judgement. The Flamm and Geiger VBAC risk score is a simple


#### **Table 2.**

*Queensland Clinical Guideline Vaginal birth after caesarean (VBAC) which was adopted by Royal College of Obstetricians and Gynaecologists [21, 22].*


#### **Table 3.**

*Flamm and Geiger model VBAC risk score [43].*

and popular tool of prediction of successful VBAC which uses 5 parameters with scores allocated as shown in **Table 3** [43]. In an analysis of the predictiveness and positive correlation of the Flamm and Geiger scoring system in a prospective observational study, it was found that most women with scores of <3 at the time of admission had emergency caesarean section and successful VBAC accounted for only 16%, while score of >8 had a success VBAC rate of 100% and the authors concluded that the application of the Flamm and Geiger scoring gave a fair judgement of successful VBAC rates [43]. In a much larger recent study in a resource constraint setting, the Flamm and Geiger admission criteria had similar outcomes, however decision also included factors like estimated fetal weight, interpregnancy interval and gestational age [44]. The Maternal-Fetal Medicine Unit Network has a VBAC calculator which incorporated maternal height, weight, pre-pregnancy BMI and devoid of race which is ethnicity. The predictive score appears to be similar to the Flamm and Geiger model [45]. https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth. html

https://www.mdcalc.com/calc/3317/vbac-risk-score-successful-vaginal-deliveryflamm-model

### **8. VBAC versus ERSC**

The risk versus benefit of VBAC and ERCS should be highlighted with full disclosure to any prospective mother who had a prior caesarean delivery. The decision for a mother to attempt either routes should be based on informed consent and be free from coercion.
