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Re: VBAC From: art fougner, md (evsono@pipeline.com) Thu Dec 16 13:04:00 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lynn D. Montgomery, M.D.: "VBAC" Previous message: Steve & Eryl Raymond: "Re: breech" In reply to: Charlie Chambers: "Re: VBAC" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: VBAC" in all honesty, does anyone really feel that trial of labor belongs in a setting other than a unit equipped to handle an emergency section within 15mins ( decision to incision)? Always felt the concept of a Trial of Labor conducted in a small community hospital disturbing. Just my opinion - I could be wrong. art At Thu, 16 Dec 2004, Charlie Chambers wrote: > >--Apple-Mail-2-357690075 >Content-Transfer-Encoding: quoted-printable >Content-Type: text/plain; > charset=ISO-8859-1; > delsp=yes; > format=flowed > >Yeah, but therein lies the rub. > >With today's medicolegal climate in the U.S., unless a trial of labor >has ZERO increased risk compared to repeat cesarean, I don't see VBAC >coming back except at large tertiary care centers. >************************************************************************ >****** >************************************************************************ > >-- >Charlie Chambers >Hood River, OR USA >cchamber@alumni.rice.edu > >"All good things...come by grace, >and grace comes by art, >and art does not come easy." > >Norman Maclean >************************************************************************ >******* >************************************************************************ > >On Dec 16, 2004, at 9:20 AM, Dr. Ainsworth wrote: > >> Good article and editorial on TOL after previous C/S in todays NEJM, >> check out website: http://www.nejm.org. Really nothing new, but it is a large >> multicenter observational study done over four years, 1997 to 2001. >> >> Background The proportion of women who attempt vaginal delivery after >> prior cesarean delivery has decreased largely because of concern about >> safety. The absolute and relative risks associated with a trial of >> labor in women with a history of cesarean delivery, as compared with >> elective repeated cesarean delivery without labor, are uncertain. >> >> Methods We conducted a prospective four-year observational study of all >> women with a singleton gestation and a prior cesarean delivery at 19 >> academic medical centers. Maternal and perinatal outcomes were >> compared >> between women who underwent a trial of labor and women who had an >> elective repeated cesarean delivery without labor. >> >> Results Vaginal delivery was attempted by 17,898 women, and 15,801 >> women >> underwent elective repeated cesarean delivery without labor. >> Symptomatic >> uterine rupture occurred in 124 women who underwent a trial of labor >> (0.7 percent). Hypoxic–ischemic encephalopathy occurred in no infants >> whose mothers underwent elective repeated cesarean delivery and in 12 >> infants born at term whose mothers underwent a trial of labor >> (P<0.001). >> Seven of these cases of hypoxic–ischemic encephalopathy followed >> uterine >> rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial >> of labor), including two neonatal deaths. The rate of endometritis was >> higher in women undergoing a trial of labor than in women undergoing >> repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as >> was the rate of blood transfusion (1.7 percent vs. 1.0 percent). The >> frequency of hysterectomy and of maternal death did not differ >> significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 >> percent vs. 0.04 percent, respectively). >> >> Conclusions A trial of labor after prior cesarean delivery is >> associated >> with a greater perinatal risk than is elective repeated cesarean >> delivery without labor, although absolute risks are low. This >> information is relevant for counseling women about their choices after >> a >> cesarean section. >> >--Apple-Mail-2-357690075 >Content-Transfer-Encoding: quoted-printable >Content-Type: text/enriched; > charset=ISO-8859-1 > ><fontfamily><param>Lucida Grande</param>Yeah, but therein lies the >rub. > >With today's medicolegal climate in the U.S., unless a trial of labor >has ZERO increased risk compared to repeat cesarean, I don't see VBAC >coming back except at large tertiary care centers. </fontfamily> > >><fontfamily><param>Helvetica</param>************************************* **************************************** > ><fontfamily><param>Helvetica</param>************************************* **************************************** >Charlie Chambers > >Hood River, OR USA > >cchamber@alumni.rice.edu > >"All good things...come by grace, > >and grace comes by art, > >and art does not come easy." > >Norman Maclean > >>************************************************************************* ***** > >************************************************************************* ***** ></fontfamily> > ><fontfamily><param>Lucida Grande</param>On</fontfamily> ><fontfamily><param>Lucida Grande</param>Dec</fontfamily> 16, 2004, ><fontfamily><param>Lucida Grande</param>at</fontfamily> 9:20 ><fontfamily><param>Lucida Grande</param>AM</fontfamily>, ><fontfamily><param>Lucida Grande</param>Dr</fontfamily>. ><fontfamily><param>Lucida Grande</param>Ainsworth</fontfamily> ><fontfamily><param>Lucida Grande</param>wrote</fontfamily>: > ><excerpt><fontfamily><param>Lucida Grande</param>Good</fontfamily> ><fontfamily><param>Lucida Grande</param>article</fontfamily> ><fontfamily><param>Lucida Grande</param>and</fontfamily> ><fontfamily><param>Lucida Grande</param>editorial</fontfamily> ><fontfamily><param>Lucida Grande</param>on</fontfamily> ><fontfamily><param>Lucida Grande</param>TOL</fontfamily> 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>cesarean</fontfamily> ><fontfamily><param>Lucida Grande</param>section</fontfamily>. > ></excerpt>--Apple-Mail-2-357690075-- > -- art fougner, md ich bin ein New Yorker Next message: Lynn D. Montgomery, M.D.: "VBAC" Previous message: Steve & Eryl Raymond: "Re: breech" In reply to: Charlie Chambers: "Re: VBAC" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: VBAC"

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