Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. ⋯ Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.
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The aim of this study was to assess the effectiveness of the different referral pathways to accessing abortion services. It was a retrospective observational study comparing abortion referral processes in two district hospitals. The results showed that 149 patients self-accessed the NHS abortion service in group A compared with group B of 365 formally referred patients. ⋯ However, 74% of patients in group A had their termination request met within 7 days of the initial appointment, compared with only 37% in group B (p = 0.0011). A total of 70% of terminations performed in group A were undertaken at less than 10 weeks' gestation, compared with only 31% in group B (p < 0.0001). It was concluded that the open referral pathway to accessing NHS abortion services, where available, appears to be effective in allowing more abortions to be undertaken at an early gestation.
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This was a retrospective review of all cases of peripartum obstetric hysterectomy performed at the Istanbul Bakirkoy Women and Children's Teaching Hospital in the period between January 2001 and September 2008. We included any women who required emergency hysterectomy to control major postpartum haemorrhage after delivery. During the study period, there were 91 cases of peripartum hysterectomy. ⋯ The main indication for emergency hysterectomy was uterine atony in 52 cases (57.1%). The most independent risk factors for emergency hysterectomy were multiparity (odds ratios (OR) 17.3, 95% confidence interval (95% CI) 8.7-34.6); caesarean delivery in index delivery (OR 6.7, 95% CI 3.8-11.9) and caesarean section for placental abruption (OR 3.8, 95% CI 0.4-33.4). Our study suggests that multiparity, primary or repeat caesarean deliveries for placental abruption are independently associated risks for peripartum hysterectomy and uterine atony is the still most common indication for peripartum hysterectomy in Turkey.
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Perimortem caesarean section (PCS) is a rare event often resulting in high mortality of mother and/or fetus. It represents a tragedy for the mother and the family and a crisis for the healthcare professionals managing such a case. This paper seeks to raise awareness of the pertinent issues surrounding PCS and challenges care providers to put in place procedures to deal with this catastrophic event. It also reviews the historical perspective of PCS, maternal physiology during cardiopulmonary resuscitation (CPR), prognostic factors for maternal and fetal wellbeing, techniques of PCS, survival for mother and baby and the medico legal aspects of PCS.