Usually, a vaginal delivery is the safest route of delivery even after a previous lower segment cesarean delivery. Some women may request a primary or a repeat cesarean section to avoid experiencing labor. This is an option provided the patient is fully aware of the risks versus benefits.
In the USA, a reduction in the stillbirth rate was noted when the cardiotocography/nonstress test (NST) was introduced for the management of high-risk pregnancies.[154] However, there is a high prevalence of false-positive nonreassuring tests. For predicting adverse pregnancy outcomes, the biophysical profile (BPP) has a low false-negative rate but a high false-positive rate and is comparable to cardiotocography/NST. The modified biophysical profile (MBPP), which includes a nonstress test and an amniotic fluid index measurement, is as reliable and much easier to perform than the full biophysical profile.[155] The modified biophysical profile is considered abnormal if either the nonstress test is non-reactive or if the deepest vertical pocket of amniotic fluid is less than 2 cm. Although evidence to support the ability of the BPP and the MBPP to reduce stillbirth is lacking, the American College of Obstetrics and Gynecology supports starting testing no earlier than 32 weeks 0 days of gestation for high-risk pregnancies and sooner only if delivery is considered to impact perinatal benefit.[156][157]
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