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Re: Arrest of DilationFrom: D. Ashley Hill (dahmd@cfl.rr.com)Thu Aug 3 19:49:07 2006
I would add that the data suggesting an increase in maternal morbidity with cesarean delivery has been disproven with regards to elective cesareans. One cannot compare patients having an elective cesarean with a cesarean after a long labor. In fact, there is some evidence to guide us from a large series of patients in Nova Scotia (2003), which I abstracted below from Medline. There are other studies supporting this premise. Using these data, one could conclude that the informed consent process should include information that having labor and ending up with a cesarean is a setup for the most morbidity, as a physician patient explained to me after requesting an elective cesarean. As Henry suggests, it's tough to give informed consent about vaginal delivery, assisted operative delivery, and cesarean delivery because of all the variables with mom, the labor process, and the baby. Obstet Gynecol. 2003 Sep;102(3):477-82. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Allen VM, O'Connell CM, Liston RM, Baskett TF. OBJECTIVE: To estimate the maternal morbidity associated with cesarean deliveries performed at term without labor compared with morbidity associated with spontaneous labor. METHODS: A 14-year study (1988-2001) compared maternal outcomes in nulliparous women at term undergoing spontaneous labor for planned vaginal delivery with singleton, cephalic presentation and nulliparous women delivering by cesarean without labor. RESULTS: There were no maternal deaths or transfers for intensive care. There was no difference in wound infection, blood transfusion, or intraoperative trauma. Women undergoing cesarean deliveries without labor were more likely to have puerperal febrile morbidity but were less likely to have early postpartum hemorrhage compared with women entering spontaneous labor. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups. CONCLUSION: The increased maternal morbidity in elective cesarean delivery compared with spontaneous onset of labor is limited to puerperal febrile morbidity. Maternal morbidity is increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor. Ashley ------------------
At Thu, 3 Aug 2006, Henry Gregor wrote:
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> -- ------------------ >Respectfully, I didn't say anything about doing a particular section on a particular patient, Sue. Perhaps you are responding to someone else's post. > > Also, respectfully, a 4 fold maternal death rate is a very challengeable statement. The universe of c/s morbidity and mortality data is a heterogenous world. Scheduled, emergent after minimal, or after prolonged, labor, w or w/o ROM, w or w/o medical maternal comorbidity(ies), w or w/o maternal or fetal distress, or both....one needs to qualify what's being compared. The literature cites numbers all over the map, for all of these categories. More than a few note mortality for scheduled cs w/o labor at equal or less than that of SVD. > > Some years ago, JAMA published a study comparing SVD and a well defined CS category, with rates reversed for CA and RI. The editorial comment was somewhat amusing, with the commentor noting that perhaps anyone planning such a CS might be advised to pick her state of delivery as carefully as her provider and facility. > H > >Stmidwife@aol.com wrote: > > Respectfully, Hank, I, on the other hand would have to point out that c-sect carries a 4 fold maternal death rate. I don't think that this is a place to start since babies do engage often in labor, pelvis's do have give and babies heads mold to fit into the pelvis. If her pelvis was that grossly abnormal, I am sure that someone would have ruled her out as a vaginal birth candidate on her initial visit. > > Sue > >Colossians 3:12: And so, as those who have been chosen of God, holy and beloved, put on a heart of compassion, kindness, humility, gentleness and patience… > > Next-gen email? Have it all with the all-new Yahoo! Mail Beta.
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