Reference: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11084564&dopt=Abstract
Am J Obstet Gynecol 2000 Nov;183(5):1184-6
Effect of previous vaginal
delivery on the risk of uterine rupture during a subsequent trial
of labor.
Zelop CM, Shipp TD, Repke JT, Cohen A, Lieberman E.
Department of Obstetrics and Gynecology, Lenox Hill Hospital, New
York, NY 10021-1988, USA.
OBJECTIVE: We examined the effect of prior vaginal delivery
on the risk of uterine rupture in pregnant women undergoing a trial
of labor after prior cesarean delivery.
STUDY DESIGN: The medical records of all pregnant women with
a history of cesarean delivery who attempted a trial of labor during
a 12-year period at a single center were reviewed. For the current
analysis, the study population was limited to term pregnancies. The
effect of previous vaginal delivery on the risk of uterine rupture
during a subsequent trial of labor was evaluated. Separate analyses
were performed for women with a single previous cesarean delivery
and for those with >1 prior cesarean delivery. For each of these subgroups,
the rate of uterine rupture among women who had > or =1 prior vaginal
delivery was compared with the rate among women with no prior vaginal
delivery. Logistic regression analysis was used to examine the associations
with control for confounding factors.
RESULTS: Of 3783 women with 1 prior scar, 1021 (27.0%) also
had > or =1 prior vaginal delivery. During a subsequent trial of labor,
the rate of uterine rupture was 1.1% among pregnant women without
prior vaginal delivery and 0.2% among pregnant women with prior vaginal
delivery (P =.01). Logistic regression analysis controlling for duration
of labor, induction, birth weight, maternal age, year of birth, epidural
analgesia, and oxytocin augmentation indicated that, among women with
a single scar, those with a prior vaginal delivery had a risk of uterine
rupture that was one fifth that of women without a previous vaginal
delivery (odds ratio, 0.2; 95% confidence interval, 0.04-0.8). In
the group of 143 pregnant women with >1 previous cesarean delivery,
women with a prior vaginal delivery had a somewhat lower risk of uterine
rupture (3.9% vs 2.5%; adjusted odds ratio, 0.6; 95% confidence interval,
0.01-6.7). This difference was not statistically significant.
CONCLUSION: Among women with 1 prior cesarean delivery undergoing
a subsequent trial of labor, those with a prior vaginal delivery were
at substantially lower risk of uterine rupture than women without
a previous vaginal delivery.
Reference: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9790374&dopt=Abstract
Am J Obstet Gynecol 1998 Oct;179(4):938-41
Trial of labor after cesarean
delivery: the effect of previous vaginal delivery.
Caughey AB, Shipp TD, Repke JT, Zelop C, Cohen A, Lieherman E.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital,
Boston, Massachusetts, USA.
OBJECTIVE: This study examined the effects of order of previous
modes of delivery on the rate of cesarean delivery and duration of
a trial of labor among women with a history of 1 previous cesarean
delivery and 1 previous vaginal delivery.
STUDY DESIGN: The medical records of 4393 women at our institution
who were seen June 1984-July 1996 for a trial of labor after a previous
cesarean delivery were abstracted. The 800 women with a history of
1 previous cesarean and 1 previous vaginal delivery were included
in this analysis. They were split into 2 groups by obstetric history:
(1) 1 cesarean delivery followed by 1 vaginal delivery (vaginal last)
and (2) 1 vaginal delivery followed by 1 cesarean delivery (cesarean
last). Patient characteristics, durations of labor, and rates of cesarean
delivery were compared with chi2 analysis, the Student t test, and
the Wilcoxon rank sum test. Possible confounding variables were controlled
for with multivariate logistic regression. RESULTS: The rates of cesarean
delivery for the vaginal last and cesarean last groups were 7.2% and
14.7%, respectively (P = .002). The median durations of labor for
the vaginal last and cesarean last groups were 5.6 and 7.0 hours,
respectively (P = .01). The differences in cesarean rates and durations
of labor were seen regardless of the indication for the previous cesarean
delivery.
CONCLUSIONS: Among women with 1 previous cesarean and 1 previous
vaginal delivery, those whose most recent delivery was vaginal had
a lower rate of cesarean delivery and shorter duration of labor than
did those whose most recent delivery was cesarean.
OBSTETRIC COMPLICATIONS AMONG
OLDER WOMEN CANNOT EXPLAIN THEIR HIGH CAESAREAN RATES.
(Do obstetric complications explain high caesarean section rates among
women over 30? A retrospective analysis)
http://bmj.com/cgi/content/full/322/7291/894
Delivery by caesarean section is associated with advancing age, yet
a study in this week's BMJ finds that this relation cannot be entirely
explained by obstetric complications among older women. This raises
the question of why rates for caesarean section are high amongst older
mothers. The research team analysed over 23,000 deliveries to Aberdeen
residents aged at least 20 years during 1988-97. Details of obstetric
complications and interventions associated with a higher probability
of caesarean section were used to investigate the association with
age. Among women who had not previously had a caesarean section and
whose babies presented normally at delivery, there was a strong and
consistent relation between maternal age and delivery by caesarean
section that remained after controlling for relevant obstetric complications
and other confounding factors. In contrast, the association between
maternal age and both elective and emergency sections was either small
or completely absent among women who had previously had a caesarean
section or whose babies presented abnormally at delivery.
These results suggest that the relation between maternal age and
caesarean section cannot be entirely explained by the obstetric complications
considered in this study. Physician and maternal preference may explain
the higher section rates among older women, say the authors. However,
further investigation is needed into women's views about increased
intervention, the variation in rates for caesarean section among obstetricians,
and how maternal age influences both of these factors, they conclude.
Contact: Angela Begg, Public Relations Office,
University of Aberdeen, King's College Aberdeen, Scotland.
Email: a.begg@abdn.ac.uk
Doctors recommends INFORMED
CONSENT for Cesareans.
Brent Rooney
www.vcn.bc.ca/~whatsup
This belongs in the category of 'believe it or not': Three MD's recommending
in a mainstream medical journal that before women undergo Cesareans
that they be warned of the much-increased risk of 'persistent pulmonary
hypertension' of the newborn. (Mode of Delivery and Risk of Respiratory
Diseases in Newborns, Elliot M. Levine , et al. Obstetrics & Gynecology
2001;97:439-442) PPH (formerly termed persistent fetal circulation)
is a life-threatening problem of neonates. Women undergoing elective
Cesareans sections had a rate of PPH of 3.7 per thousand live births,
versus 0.8 per 1000 live births for women having vaginal deliveries.
I.E. the Cesarean risk of PPH was 4.6 times that of vaginal birth.
From the authors: "Conclusion: The incidence of persistent pulmonary
hypertension of the newborn was approximately 0.37% among neonates
delivered by elective cesarean, almost fivefold higher that those
delivered vaginally. The findings have implications for informed consent
before cesarean and increased surveillance of neonates after cesarean."
It is extremely rare for medical journals to discuss informed consent
in the context of a specific (!) medical treatment. However, proper
informed medical consent is a protection for both (!) doctor and patient.
Unless better informed consent is provided, the 'Internet age' will
see an escalation in medical malpractice suits, 'believe it or not'.
MEN AND WOMEN RECOVER DIFFERENTLY
AFTER SURGERY
(Sex differences in speed of emergence and quality of recovery after
anaesthesia: cohort study)
http://bmj.com/cgi/content/full/322/7288/710
Women emerge more quickly than men from general anaesthesia, but
have a slower return to former health after surgery, according to
a study in this week's BMJ.
Researchers at Alfred Hospital in Australia studied 241 men and 222
women for three days after undergoing surgery to identify differences
in the quality of recovery between the sexes. They found that women
emerged significantly more quickly than men from general anaesthesia
but overall quality of recovery was worse.Women had a 25% slower rate
of return to their preoperative health status and were more likely
to have minor postoperative complications, such as nausea and vomiting,
headache, backache and sore throat.
Underlying physiological differences between men and women may help
to explain these findings, say the authors. For example, postoperative
nausea and vomiting has been related to the phase of the menstrual
cycle and women have a higher incidence of migraine and tension headaches
generally (a risk factor for postoperative headache). Postoperative
backache may also be attributed to anatomical differences between
men and women.
Such differences, which have previously received limited attention,
are genuine and important, they conclude.
Contact: Paul S Myles,
Head of Research, Department of Anaesthesia and Pain Management,
Alfred Hospital, Prahran, Victoria, Australia
Email: p.myles@alfred.org.au
Uterine Rupture Risk After
Prior Cesarean Not Increased After 40 Weeks' Gestation
WESTPORT, CT (Reuters Health) Mar 13 -Among women with one previous
cesarean delivery, the risk of uterine rupture during a subsequent
trial of labor is not substantially increased after 40 weeks' gestation,
according to a report in the March issue of Obstetrics and Gynecology.
However, the risk is increased with induction of labor regardless
of gestational age.
Dr. Carolyn M. Zelop, of Lenox Hill Hospital, New York, and colleagues
compared outcomes in women with prior cesareans delivering at or before
40 weeks with those delivering after 40 weeks. They reviewed labor
outcomes over 12 years for 2775 women "with one prior scar and no
other deliveries" who had a trial of labor at term.
According to the report, uterine ruptures occurred in 0.8% of women
delivering at or before 40 weeks' gestation and 1.3% of women delivering
after 40 weeks. Among those with spontaneous labor, the rupture rate
was 0.5% at or before 40 weeks and 1.0% after 40 weeks (OR 2.1). With
induced labor, the rates were 2.1% and 2.6%, respectively (OR 1.1).
The overall rate of cesarean delivery was higher for women after 40
weeks' gestation compared with women at or before 40 weeks, at 35.4%
and 26.7%, respectively. The rate of cesareans associated with spontaneous
labor at or before 40 weeks was 25%, compared with 35.5% after 40
weeks for (OR 1.5). For induced labor, the rates of cesarean delivery
were 33.8% and 43%, respectively (OR 1.5).
"Because spontaneous labor after 40 weeks is associated with a cesarean
rate similar to that following induced labor before 40 weeks, awaiting
spontaneous labor after 40 weeks does not decrease the likelihood
of successful vaginal delivery,"Dr. Zelop and colleagues conclude.
Obstet Gynecol 2001;97:391-393.
High Rate of Persistent Pulmonary
Hypertension Seen in Babies Born by C-Section
WESTPORT, CT (Reuters Health) Mar 01 - The incidence of persistent
pulmonary hypertension in newborns delivered by cesarean section is
nearly five times higher than that observed among babies delivered
vaginally, according to a database analysis of deliveries at the Illinois
Masonic Medical Center, in Chicago.
Among 25,318 deliveries between 1992 and 1999, 4301 were cesareans,
report Dr. Elliot M. Levine and associates in the March issue of Obstetrics
& Gynecology. The incidence of persistent pulmonary hypertension was
4.0 per 1000 live cesarean births, compared with 0.8 per 1000 live
vaginal births.
The authors suggest that labor and vaginal delivery, perhaps by physical
compression in the birth canal, is advantageous for the pulmonary
vascular bed of the neonate. They advise obstetricians to discuss
the increased risk of pulmonary hypertension associated with cesarean
section when offering a woman delivery options.
Obstet Gynecol 2001;97:439-442.
AMA REJECTS PLAN FOR PATIENTS
TO VIEW MEDICAL RECORDS
(The World Today: 14/5/2001)
From December this year, if you visit a doctor's surgery or go to
a hospital for treatment, you will have the right as a patient to
demand access to your own medical records.
Some summaries of the above reportsÉ
This is a transcript of AM broadcast at 0800 AEST on local radio
ÒWhile consumer groups applaud the initiative, the AMA claims that
patients could be harmed by reading their own records and that doctors
already do a good job of guarding privacy.
Leigh Sales reports.
LEIGH SALES: The Privacy Commissioner says the proposed laws will
strengthen consumer choice and control over health information. But
doctors disagree, saying it's simply bogging them down in more bureaucratic
red tape without really improving patient privacy.Ó
AndÉ
AMA rejects plan for patients to view medical records
The World Today - Monday, May 14, 2001 12:46
ÒJOHN HIGHFIELD: From December this year, if you visit a doctor's
surgery, or go to a hospital for treatment in Australia, you will
have the right of access to your own medical records. In this information
age, this hardly seems like a big deal. But in the medical world,
which has relied on professional oaths of confidentiality for thousands
of years, it really is a quantum shift.Ó
Editor Ð I had received the email below in query to the patientÕs
rights to gain possession of their hospital records. Each state will
have itÕs own legislation in regard to these rights, but I hope that
things are changing in response to the reports above, about hospital
records and patientÕs rights to their medical information.
Hi Jackie,
I am having a lot of difficulty (that being an understatement) gaining
access to my hospital records. I have written to my OB requesting
a full set of records twice and have sent a third letter requesting
a summary if nothing else. He hasn't even replied to say "no". I have
since requested the records from the first hospital I stayed at. In
this situation I was a private patient in a public hospital. However
in the second case, I was a private patient in a private hospital.
I believe the laws governing Freedom of Information are that I have
a right to the information from the public hospital but not from the
private. I am being told that the OB/GYN (lets just refer to him as
the butcher) does not have to divulge any information - that they
are his property. Is this right? I would appreciate any advice/thoughts/info
you can offer. I'm becoming increasingly frustrated with this fellow
- perhaps he is hiding something? be.
Danielle.
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