| Other Years | 1916-1989 | 1990-1994 | 1995-1999 | 2000-2004 | 2005-2009 |
|---|---|---|---|---|---|
| Complete Collections | Word | FileMaker Pro |
compiled primarily by: Philip J. Rosenow, M.D. < philip "at" netpath "dot" net >
HTML and additions by: Ken Turkowski, research scientist
Primary sort by: Date of Publication, Secondary sort by: Author, Last Search: 6/2005
Disclaimer: This bibliography has been made publicly accessible in order to faciltate research by medical professionals. No claim is made for accuracy of the contents, nor is any guarantee made to update it over time, although we have updated it quarterly since 1996. Use at your own discretion.
| 1999 | ||||||
|---|---|---|---|---|---|---|
| Author | Title | Journal | vol | pg | yr | Abstract |
| Abitbol | Prediction of difficult vaginal birth and of CS for cephalopelvic disproportion in early labor | J Mat Fet Med | 8 | 51 | 1999 | A total of 1692 patients were eval. In early labor. Predictions for were made combining clinical pelvimetry and fetal measurements on US for: 1. easy labor-vaginal birth, 2. difficult labor vaginal birth and 3. improbable vaginal birth-CS. The combined prediction either 2 or 3 was very accurate (362 of 370 or 97.8%) but the prediction of 2 and 3 was less significant. A similar prediction for 141 VBAC candidates showed that by sectioning electively the patients in whom CS was predicted would barely increase the CS rate. |
| Abu - Heija (Jordan) |
Emergency peripartum hysterectomy at the Princess Badeea Teaching Hospital in north Jordan | J OG Gyn Res | 25 | 193 | 1999 | Evaluation of 21 emergency peripartum hysterectomies with overall incid of 0.5/1,000 deliveries. 38% associated with abnormal placenta (many also had PCS) 33.3% were for ruptured uterus. |
| Blanchette | Comparison of the safety and efficacy of intravaginal misoprostol with those of dinoprostone for cervical ripening and induction of labor. | AJOG | 180 | 1551 | 1999 | Retro, looked at 81 patients undergoing cervical ripening or induction of labor with prostaglandin E2 (dinoprostone). A comparison prospective analysis of 145 patients undergoing the same procedure with prostaglandin E1 (misoprostol). Findings: mean time to delivery was shorter in the misoprostol group, there was no increased cesarean rate, the incidence of hyperstimulation was higher in dinoprostone group. There were 2 uterine ruptures and one dehiscence with misoprostol group in patients attempting VBAC and 1 rupture in patients without uterine scar. |
| Callahan (UNC-CH) |
Safety and efficacy of attempted VBAC beyond the EDC | JRM | 44 | 606 | 1999 | Computerized database analyzed for attempted VBAC beyond 40 weeks. 90 pts matched with 90 controls. Results: successful VBAC was 65.6% compared with 94.4% of controls. Also found that 62% were successful is there were no previous vaginal births, 82% success was found if patient had at least one prior vaginal birth. Conc: the patient can be reassured that passing her due date does not alter the efficacy or safety of a TOL. No change in counseling is warranted simply due to the completion of 40 weeks' gestation. |
| Caron | The effect of public accountability on hospital performance: trends in rates for CS and VBAC in Cleveland, Ohio | Qual Manag Health Care | 7 | 1 | 1999 | 14 item survey based on Joint Commission on Accreditation of Healthcare Organization admin to Cleveland hospitals to see if they have responded to public concern about improving CS and VBAC rates. Results showed that all hospitals are a various stages of the process to improve their CS and VBAC rates. From this, it is proposed that public accountability encourages quality improvement. |
| Caughey (Harvard) |
Rate of uterine rupture during a TOL with one or two PCS | AJOG | 181 | 872 | 1999 | Retro, all cases of TOL in 12 years at Brigham reviewed in patients with one PCS compared with two PCS. Women with one PCS (n=3757) had UR rate of 0.8% whereas those with 2 PCS (n=134) had rupture rate of 3.7%. Using logistic regression to control for variables, they found the odds ratio for UR in pts with 2 PCS was 4.8%. Conclusion: women with 2 PCS have an almost 5 fold greater risk for uterine rupture. |
| Chuang (Columbia University) |
TOL versus ERCS for the women with a previous CS: a decision analysis | Proc AMIA Symp | 226 | 1999 | Decision analysis constructed, found "more patients' preference studies are needed" | |
| Cunha (Mozambique) |
Induction of labor by vaginal misoprostol in patients with PCS | ActaObGynScand | 78 | 653 | 1999 | Modified, case-referent study comparing 57 patients attempting TOL after PCS with 57 patients Hx of PCS and an indication for induction. Conclusion: In a setting where human and material resources are extremely scarce, TOL by indicated induction with vaginal misoprostol is potentially a valuable alternative. |
| Faridi | 2 or more CS-elective repeat or vaginal delivery | Zgeburtshilfe Neo | 203 | 8 | 1999 | Review, quotes UR of 0-2.8% with fetal bradycardia as a diagnostic sign. Prompt intervention is necessary to minimize both fetal and maternal complications. At present there is no sufficiently predictive method to identify those women most likely to benefit from an elective CS. |
| Gregory (Cedars Sinai Medical Center) |
VBAC and UR rates in California | OG | 94 | 985 | 1999 | Ca discharge summaries to gather data. 536,785 deliveries in 1995, there was a 20.8% CS rate and 12.5% of patients had Hx of previous CS. Of women with PCS, 61.4% attempted VBAC and 34.8% were successful. There were 392 UR (0.07%), women with PCS were 17 times more likely to have UR. |
| Grischke (Heidelberg) |
Puerperal uterine inversion with covered uterine rupture | Zgeburtshilfe Neo | 203 | 123 | 1999 | Case report of uterine inversion after a PCS uterine rupture. |
| Haney (Northwestern) |
Optional vaginal delivery rate. An informative indicator of intrapartum care. | JRM | 44 | 842 | 1999 | Developed a statistical model with the following categories: V-S=standard vaginal, V-O=optional vaginal, C-S=standard cesarean and C-PA=potentially avoidable cesarean. A weighted equation was developed generating physician delivery scores, giving "extra credit" for V-O and a "debit" for C-PA. Conc: the optional vaginal delivery rate and delivery score are more informative indicators of intrapartum management acumen than is CS rate alone. |
| Lehmann (Paris) |
Predictive Factors of the delivery method in women with CS scars | J GO Bio Repro | 28 | 358 | 1999 | Retro, multi center of 579 pts with PCS and who deliverer from 1/95-6/97. the rate of successful TOL was 74.5%, overall the morbidity was not increase in the TOL group. Conc: TOL should be allowed in most of the women with PCS. The bishop's score is the best predictor of mode of delivery. Induction of labor and a first CS for dystocia do not affect the chances of vaginal birth. |
| Macones (U of Penn) |
The utility of clinical tests of eligibility for a TOL following a CS: a decision analysis | BJOG | 106 | 642 | 1999 | Theoretical evaluation of 2 strategies for treating women with PCS: TOL for all or application of a hypothetical test. Conc: in developing tests to determine to whom to offer a TOL, investigators and clinicians must realize that a highly sensitive and specific test is needed. |
| Marcus (U of Washington) |
Extrauterine pregnancy resulting from early UR | OG | 94 | 804 | 1999 | Case report, Hx of 2 previous CS, presented at 13 weeks gestation c/o cramping and spotting. Ultrasound and magnetic resonance showed probable uterine dehiscence and a viable extrauterine pregnancy. Uterine arteries were embolized with subsequent fetal death. Exploration showed an complete rupture with the pregnancy enclosed within scar tissue between the uterus and the bladder. |
| Mastrobattista (U of Texas) |
Vaginal Birth after cesarean delivery | OGCNA | 26 | 295 | 1999 | Review of VBAC. |
| McNally (Dublin) |
Induction of labour after 1 previous CS | Aust NZ JOG | 39 | 425 | 1999 | Retro, 103 pts with PCS had labour induced. The repeat CS rate after induction was 20.4%, of the 51 patients who had never delivered vaginally before the CS rate was 37% compared with only 3.9% of those who had delivered vaginally previously. 14 patients with no previous vaginal delivery and an unfavorable cervix had a CS rate of 64%. The commonest indication for induction was postdates. There were 2 cases of scar rupture. Conclusion: there is a higher incid of CS in patients being induced who have not had a previous vaginal delivery and in those whose cervix is not effaced. |
| Menihan (Brown U.) |
The effect of uterine rupture on FHT patterns | J Nurse Midw | 44 | 40 | 1999 | The only reported predictable feature of FHT patterns in response to UR is the sudden onset of fetal bradycardia. |
| Montanari | Transvaginal US evaluation of the thickness of the section of the uterine wall in PCS. | Minerva Ginecol | 51 | 107 | 1999 | 61 pts at 37-40 weeks gestation with Hx of PCS had TVUS. Wall thickness, cervical length, dilation of the isthmus were measured. Found that a thickness cutoff of 3.5mm of the lower uterine segment had a positive predictive value of 60.7% and a negative predictive value of 100%. |
| Pasternak | Risk-adjusted measurement of PCS: reliable assessment of the quality of ob services | Qual Manag Health Care | 8 | 47 | 1999 | Found a 2 hospital system with widely disparate CS rates. Statistical analysis determined that the apparent discrepancy was due primarily to patient related factors. |
| Perrotin (Paris) |
Scarred uterus: is routine exploration of the CS scar after VBAC always necessary? | J GO Bio Repro | 28 | 253 | 1999 | Retro, found 3 uterine ruptures (0.43% of all scarred uterus) and 14 dehiscences (2%) during ten years of evaluation. All UR were symptomatic, no dehiscence required surgical Rx. Conc: exploration should be performed only in symptomatic patients |
| Plaut | Uterine rupture associated with the use of misoprostol in the gravid patient with a previous CS | AJOG | 180 | 1535 | 1999 | Case report and review of the literature. 89 patients attempting VBAC received Cytotec for induction, 5 had a uterine rupture (5.6% versus 0.2% who did not receive Cytotec) "Review of the literature reveals insufficient data to support the use of misoprostol in the patient with a PCS. |
| Quinlivan | Patient preference the leading indication for ERCS in public patients–results of a 2 year prospective audit in a teaching hospital | Aust NZ JOG | 39 | 207 | 1999 | Prospective audit, 9,138 deliveries, 1,624 by CS for an overall rate of 17.8%. Of these, 633 (39%) were ERCS and 911 (61%) were non elective. The most common indication for ERCS was maternal choice, largely due to refusal of TOL. |
| Rageth (Switzerland) |
Delivery after previous cesarean section: a risk evaluation | OG | 93 | 332 | 1999 | Pooled data from Switzerland. 457,825 deliveries of which 29,046 had history of previous CS. There was a trial of labor rate of 65.5% for 17,613 trials. The success rate overall was 73.3%, 75% for spontaneous labor and 65.6% for induced labor. The following were sig. more frequent in the previous CS group: maternal fever, thromboembolic events, bleeding d/t previa, uterine rupture (92 cases), perinatal mortality (118 cases including 6 associated with uterine rupture). The risk of uterine rupture was higher in the TOL gp versus the repeat CS gp but all other risks were lower in the TOL gp. In the TOL group, the uterine rupture group (70) more often had induced labor(24.9% versus 13.9% in the non rupture gp), etc. Conc.: A history of CS sig. elevates the risks for mother and child with future deliveries. Nonetheless, a TOL after PCS is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal FHT pattern are all associated with a failure of TOL and uterine rupture. |
| Raskin (U of Okla.) |
Uterine rupture after use of a prostaglandin E2 vaginal insert during VBAC. A report of 2 cases | JRM | 44 | 571 | 1999 | Case report of 2 UR in patients among 57 pts attempting VBAC. Both patients were Rxed with prostaglandin E2 developed signs of UR: persistent suprapubic pain and repetitive FHT variable decelerations followed by bradycardia. |
| Ravasia (U of Calgary) |
Incid. Of UR among women with mullerian duct anomalies who attempt VBAC. | AJOG | 181 | 877 | 1999 | 1813 attempted VBAC, 25 with known mullerian anomalies. The rates of UR were 8% in those patients with Hx of mullerian anomalies versus .61% without the anomalies. The rates for abnormal FHT, operative vaginal delivery and cord prolapse were higher in the mullerian duct anomalies group. Conclusion: Vaginal delivery is common among women with mullerian duct anomalies who attempt VBAC but rates of uterine rupture and other complications are higher. |
| Rayburn (U of Okla.) |
Weekly administration of prostaglandin E2 gel compared with expectant management in women with PCS. Prepidil Gel Study Group. | OG | 94 | 250 | 1999 | Compared safety and effectiveness of prostaglandin gel versus expectant management of unfavorable cervix in a randomized, multicenter study in patients appropriate for VBAC. Random assigned to 0.5 mg PGE2 weekly for up to 3 doses starting at 39 weeks. Conc: Safety confirmed but did not improve the likelihood of vaginal delivery. |
| Ripley (U of Fla) |
Uterine emergencies. Atony, inversion and rupture | OGCNA | 26 | 419 | 1999 | Review of uterine atony, inversion and rupture. |
| Rose | ACOG urges a cautious approach to VBAC. | Am Fam Phys | 59 | 474 | 1999 | |
| Rozenberg (U of Paris) |
Thickness of the lower uterine segment: its influence in the management of patients with PCS | Eur JOG Repro Bio | 87 | 39 | 1999 | Prospective open study, 198 pts with PCS underwent US measurement of LUS compared to a similar population in the previous years whose measurements were not provided to the treating obstetrician. Findings: the rate of vaginal delivery did not vary between the two groups (70% versus 67% controls), those who had measurements provided had a higher elective CS rate but this was balanced off by fewer emergency CS (emergency CS rate 6.3% for measured versus 23.4% of controls). |
| Sachs Frigoletto |
Editorial: the risks of lowering the CS-Delivery rate | NEJM | 340 | 54 | 1999 | Sounding Board. Contends that the advantages of vaginal delivery over CS only apply to safe vaginal deliveries and that reducing the rate of CS may lead to higher costs and more complications for mothers and their babies. Discusses the effects of Department of Health and Human Services' Healthy People 2000 objective in relation to the article. The two strategies proposed to reduce the CS rate, increasing the number of VBAC and increasing the number of operative vaginal deliveries, are associated with uterine rupture and neonatal trauma, respectively. Patients must be allowed participation in the decision involving risks to themselves and their babies. |
| Sanchez - Ramos (U of Fla.) |
Cervical ripening and labor induction with a controlled release dinoprostone vaginal insert: a meta-analysis. | OG | 94 | 878 | 1999 | Meta-analysis of 8 studies included 964 subjects, 490 had dinoprostone vaginal insets and 474 had other prostaglandin preparations. Found that those who received the inserts had a lower incid. of vaginal delivery within 12 hours, longer intervals from insert to delivery and lower rates of active labor. |
| Schnitker | UR during TOL: risk management recommendations | J health Risk Manag | 19 | 12 | 1999 | Overview of the risk management of VBAC with recommendations for mitigating the risks of VBAC. |
| Shipp (Mass General) |
Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions | OG | 94 | 735 | 1999 | Retro record review of TOL after PCS over 12-year period. The outcomes of 2912 pts with previous transverse incision and 377 pts with vertical incisions undergoing TOL were compared. Overall, there were 38 (1.3%) scar disruptions in the low transverse group and 6 (1.6%) in the low vertical group. Conc: gravids with prior low vertical uterine incision are not at increased risk for UR during a TOL compared with women with prior low transverse incisions. |
| Socol (Northwestern) |
VBAC: an appraisal of fetal risk | OG | 93 | 674 | 1999 | Retro, 91991-1996, 2082 pts with one or more PCS were allowed a TOL, 1677 of whom delivered vaginally and 405 of whom had repeat CS. There were 920 elective repeat CS. Overall, 22,863 patients without a PCS delivered vaginally and 2432 pts were delivered by primary CS after laboring. Comparisons of Apgar scores at 5 minutes and umbilical cord arterial pH were made between groups. Results: the only sig. differences were noted between those patients who had successful VBAC and those who delivered vaginally without PCS. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes < 7 or a pH < 7.1. Those neonates, however, were not at greater risk for an Apgar score of < 4 or a pH of < 7.0. Conc: Suggests that VBAC poses a low level of fetal risk, although a much larger sample size would be required to exclude a 2-fold increase. |
| Taylor (Australia) |
An evaluation of prostaglandin E2 vaginal gel use in practice | J Clin Pharm Ther | 24 | 303 | 1999 | Found no difference in effectiveness, as measured in terms of mode of delivery, was detected. |
| Vause | Evidence based case report: use of prostaglandins to induce labour in women with PCS. | BMJ | 318 | 1056 | 1999 | Case report and literature review. Found a dearth of evidence based information from which to assess the risks and benefits of using prostaglandins to induce labour in pts with a history of PCS. |
| Wing | VBAC: selection and management | Clin OG | 42 | 836 | 1999 | Review article |
| Yamani (Saudi Arabia) |
Induction of labor with vaginal prostaglandin-E2 in grand multiparous women with one PCS. | Int J GO | 65 | 251 | 1999 | 26 grandmultips with one PCS were induced with vaginal prostaglandin-E2. 77% were successful, 23% had emergency CS. The mean duration of labor was 6 hours. There were no uterine ruptures or dehiscence. There was one neonatal death and 2 stillborns. Conc: limited study suggests that induction of labor with vaginal prostaglandin-E2 in selected grandmultips with one PCS may be a reasonable option. |
| Zelop (Harvard) |
UR during induced or augmented labor in gravid women with one PCS. | AJOG | 181 | 882 | 1999 | Retro, 12-year period, compared TOL in pts with one PCS in spontaneous labor (n=2214) versus those requiring induction with oxytocin or prostaglandin E(2) gel (n=560). The overall rate of UR was 0.7% in spontaneous labor versus 2.3% in the induction group. Using logical regression analysis to eliminate variables, they found that induction with pitocin resulted in a 4.5 fold increased uterine rupture and use of prostaglandin E(2) gel was associated with an odds ratio of 3.2. Conclusion: Induction of labor with oxytocin is assoc with an increased rate of UR. Use of oxytocin for augmentation of labor should proceed with caution. |
| Ziadeh (Jordan) |
Obstetric uterine rupture: a 4 year clinical analysis | Gyn Ob Invest | 48 | 176 | 1999 | Retro review to identify risk factors of UR. Review of multiple etiologies of UR and management strategies. |
| 1998 | ||||||
|---|---|---|---|---|---|---|
| Author | Title | Journal | vol | pg | yr | Abstract |
| Cesarean Section Policy Cost Los Angeles 24 Million Dollars | OG Malpractice Prevention April 98 | 5/4 | 32 | 1998 | A county policy during the early 1990s of requiring women at public hospitals to attempt vaginal delivery before they could have a CS has cost LAC 24 million dollars in 49 malpractice cases. Although Health Services Director Mark Finucane told LAC Supervisors recently that county hospitals never forced any woman to forgo or delay a necessary CS, numerous county physicians contradicted those assertions. As interns in county hospitals, they had been told to keep the CS rate below 10%, half the rate now considered safe. | |
| Abbassi (Maroc) |
VBAC: can the trial of labor be extended | JGO Bio Reprod | 27 | 425 | 1998 | Retro, 1000 pts with PCS (85.7% one PCS, 12.9% 2 PCS and 1.4% had 3 PCS) TOL was attempted in 862 cases (86.2%) with 84.5% success. Uterine rupture occurred in 23 cases (2.7%), especially in cases with unknown scars (15 cases). No case of perinatal death related to uterine rupture was observed. |
| Abu Heija (Jordan) |
Can we reduce repeat CS at the Princess Badeea Teaching Hospital? | Clin Exp OG | 25 | 56 | 1998 | |
| ACOG | ACOG Practice Bulletin VBAC | ACOG | 2 | Oct | 1998 |
Practice bulletin. Candidates for VBAC: 1 or 2 prior LTCS, clinically adeq. pelvis, No other uterine scars or prev. rupture, Physician readily available throughout labor capable of monitoring labor and performing an emergency CS, availability of anesthesia dn OR personnel for emergency delivery. Success: overall 60-80% success but population dependent. There is no reliable scoring system to predict success. PCS for nonrecurring reasons have similar success to pts with no PCS. Approx. 50-70% of pts with dystocia are successful. Risk/Benefit: Neither VBAC nor ERCS are without risks. It is difficult to calculate cost/benefit for VBAC. Most recent studies have shown that the women attempting VBAC are at greater risk for major maternal morbidity: UR, hysterectomy and operative injury. UR can be a life threatening for both mother and infant. When catastrophic UR occurs, some patients will require hysterectomy and some infants will die or will be neurologically impaired. In most cases, the cause of UR is unknown but poor outcomes can result even in appropriate candidates. Estimated occurrence of UR is 4-9% with a classical or a "T" incision, 1-7% with a LVCS and 0.2-1.5% with a LTCS. The most common sign of UR is a nonreassuring FHT pattern with variable decelerations that may evolve into late decelerations. Other Sx are more variable and include pain, loss of station, vaginal bleeding and hypovolemia. Contraindications: Prior classical or T shaped incision, contracted pelvis, inability to perform immediate emergency CS because of unavailable surgeon, anesthesia, staff or facilities. Anesthesia: VBAC is not a contraindication to epidural anesthesia and adequate pain relief may encourage mor women to choose TOL. Epidural rarely masks the signs and symptoms of UR. Intrapartum Management: Pt evaluated promptly once labor has begun, usually use fetal monitor. Personnel familiar with the potential complications of VBAC should be present to watch for nonreassuring FHT patterns and inadequate progress in labor. Induction: Induction or augmentation has been suspected as a factor in UR. A meta-analysis found no relationship between the use of Pitocin and UR. There are occasional reports of UR with prostaglandin preparations. Summary: Level A confidence- 1. Most can be offered a TOL. 2. Epidural may be used. 3. Previous uterine incision extending into the fundus is a contraindication. |
| Al Sakka (Qatar) |
Rupture of the pregnant uterus&endash;a 20 year review | IJGO | 63 | 105 | 1998 | Retro, 31 cases of ruptured uterus, 23 cases available for study. 43.5% occurred in patients with PCS and 56.5% were in grand multips. In 43.5% uterine rupture was associated with Pitocin use. |
| Bretelle (France) |
Birth after 2 CS: the role of TOL | JGO Bio Reprod | 27 | 421 | 1998 | Retro, 184 pts with hx of 2 PCS. TOL was allowed in 96 cases with vtx presentation and normal pelvis. The success rate was 65%. There were 3 uterine scar dehiscence, one requiring hysterectomy. Neonatal outcome was good in all cases. Conc: TOL after 2 PCS is possible in the majority of cases. |
| Cadet | Occult Uterine rupture: role of ultrasound | JNat Med Assoc | 90 | 374 | 1998 | Case report of spontaneous uterine rupture complicated by pelvic infection and peritonitis. US played a primary role in the diagnosis and clearly demonstrated the uterine wall defect. |
| Caughey (Mass. Gen.) |
TOL after cesarean delivery: The effect of previous vaginal delivery | AJOG | 179 | 938 | 1998 | Record review, 4393 had TOL after previous CS. 800 women had history of A. 1 CS followed by 1 vaginal delivery (ie vaginal last) or B. vaginal delivery followed by CS. Those whose last delivery was vaginal had failed TOL/cesarean section rate of 7.2% whereas those with CS as last delivery had failed TOL/CS rate of 14.7%. The mean duration of labor for vaginal last was 5.6 hours, the duration for CS last was 7 hours. Conclusion: Among women with both a PCS and a vaginal delivery, those whose most recent delivery was vaginal had a lower rate of CS and a shorter duration of labor. |
| Chew (Singapore) |
CS and postpartum hysterectomy | Singapore MedJ | 39 | 9 | 1998 | Retro review of CS/hyst and postpartum hyst. |
| D'Ercole | Birth after 2 CS: the role of TOL | J GynOb Bio Repro | 27 | 421 | 1998 | Retro, 184 patients with Hx of 2 PCS. TOL was allowed in 96 cases with cephalic presentation and normal pelvis. The rate of success was 65%. 3 patients had a uterine scar dehiscence and in one of them a hysterectomy was required. Neonatal outcome was good in all cases. Conc: TOL after 2 pcs is possible in the majority of cases. Rate of vaginal birth is high and maternal-fetal morbidity is low. |
| de Meeus | External cephalic version after PCS: a series of 38 cases. | Eur JOG Repro Bio | 81 | 65 | 1998 | Retro, 38 women with breech, >36 weeks and hx of PCS. Version was successful in 25 (65.8%). 76% of the successful version women went on to have a VBAC for a total of 19 (50%). Success rate was less when breech was the indication of PCS. Conc: ECV is acceptable and effective in women with a prior LTCS scar when safety criteria are observed. |
| Flamm (Kaiser) |
Point/Counterpoint: I. VBAC: Where have wee been and where are we going? | OGS | 53 | 661 | 1998 | Editorial/Debate with Jeffery Phelan. Good news/bad news. Uterine rupture occurs in 1% of the cases. The good news is that 99% will remain intact and the majority of pts who attempt VBAC will deliver vaginally with no major problems. The bad news is that if the uterus does rupture there can be catastrophic medical and medico-legal consequences. Advocates a "more balanced" VBAC consent form. Before we give up on VBAC we need to remember that doing so would require an additional 112,000 cesareans next year. Because repeat CS are often more difficult we may see a corresponding inc in operative complication rates. Worst of all, it could also result in an increase in maternal deaths. Advocates not abandoning VBAC but making them safer by being ready to move very quickly when a uterine rupture does occur. A prolonged deceleration is often the first signal of uterine rupture. Perhaps it is time to ponder new guidelines for staffing and response times when a VBAC patient is in labor. |
| Green | Are we underestimating rates of VBAC? The validity of delivery methods from birth certificates | Am J Epid | 147 | 581 | 1998 | Looked at Georgia's statistics, found that cross-sectional vital records substantially underestimate VBAC and primary CS rates. |
|
Green Robert Scully (Mass General) |
Weekly Clinicopathological exercises: case 9-1998: cardiovascular collapse after VBAC | NEJM | 338 | 821 | 1998 | Case report and clinical/pathologic discussion of uterine rupture and amniotic fluid embolus in pt with VBAC (see original article for additional history). Uneventful labor except 3 decelerations lasting 2-3 minutes, epidural anesthesia with vaginal delivery. PPH with 1200 cc blood loss -- manual removal of placenta disclosing uterine rupture and adherent placenta. Profound shock and cardiac arrest followed, disproportionate to the blood loss with resuscitation unsuccessful. Ultimate pathologic diagnosis was uterine rupture, placenta accreta and amniotic fluid emboli. Good discussion follows on management and diagnosis. |
| Gyzman | Trying vaginal delivery in 1000 pts with PCS in the Antiguo Hospital Civil de Guadalajara | Ginec Ovstet Mex | 66 | 325 | 1998 | Retro, 1000 pts with hx of PCS. 67.9% were successful, there was one uterine rupture and 2 dehiscences. There were 2 fetal deaths. |
| Impey | First delivery after CS for strictly defined cephalopelvic disproportion | OG | 92 | 799 | 1998 | Retro, 1975-90, 42,793 deliveries, of which 84 met strict criteria for CPD. (cx dilation arrested after 5 cm, unresponsive of oxytocin augmentation, after active dilatation of 2 cm or more in 2 hours). 40 with cephalic presentation delivered at their hospital, all 40 had TOL. 27/40 (68%) delivered vaginally with 7 having a larger infant and 20 having a smaller infant. Of 15 women previously delivered by CS at full dilation, 11 (73%) delivered vaginally with no serious maternal or neonatal morbidity. Conclusion: the strictly defined Dx for nulliparous CPD should not constitute an automatic "recurrent" indication for elective CS. |
| Ito | Lower segment UR related to early pregnancy by in vitro fertilization and embryo transfer after a previous CS. | Jmed | 29 | 85 | 1998 | Case report, PCS had invitro fertilization which was likely implanted in the CS scar. |
| Jongen | Vaginal delivery after previous cesarean for failure of second stage of labour | Br JOG | 105 | 1079 | 1998 | Retro., 132 pts. whose first CS was done in second stage for FTP. 103 had a TOL with 82 being successful.. 40 of the vaginal births were aided by vacuum. Nearly all TOL were of spontaneous onset. There was one uterine rupture. |
| Kindig | Delayed postpartum UD. A case report | JRM | 43 | 591 | 1998 | Case report, developed delayed UD 6 weeks postpartum. The patient required hysterectomy for definitive Rx. |
| McMahon (UNC-CH) |
VBAC | Clin OG | 41 | 369 | 1998 | Review of the literature. For the majority of women with a PCS, a TOL should be encouraged. There are few absolute contraindications. Uterine rupture represents the most catastrophic complication of TOL after PCS. Women who are not successful with a TOL require repeat CS and appear to be at greatest risk for maternal complications. The management of labor in women with a previous uterine scar is not low risk. |
| Menihan (Brown U) |
Uterine rupture in women attempting a vaginal birth following prior cesarean section | J Perinatol | 18 | 440 | 1998 | Retro, 11 women with uterine rupture. No common feature in FHT or contractions activity existed except bradycardia. 91% had cord pH<7.0 and 45% had base excess > 15 meq/L. 73% infants required admission to the NICU although despite the acidemia none experienced seizures or multiorgan dysfunction. Conclusion: there is no one specific FHR or uterine activity pattern that indicates the onset of a uterine rupture, although variable and/or late decelerations occur before the onset of bradycardia. |
| Obara | VBAC: results in 310 pregnancies | JOG Res | 24 | 129 | 1998 | Retrospective, 310 pts. with PCS, 69% (214) attempted VBAC and 43% (132) were successful. No maternal or perinatal deaths occurred. There were 2 uterine ruptures 0.9%. 2.3% of VBAC gave birth to neonates with 1 minute Apgar score of =6. None of the elective CS group had such complications. |
| Ola | Rupture of the uterus at the Lagos University Teaching Hospital, Lagos, Nigeria | West Afr J Med | 17 | 188 | 1998 | Incid. of ruptured uterus was 5.01/1000 deliveries. Poor prenatal care, CPD, PCS and grandmultiparity were major etiological factors. |
| Phalen | Intrapartum fetal asphyxial brain injury with absent multiorgan system dysfunction | J Mat Fet Med | 7 | 19 | 1998 | Case report, 14 cases of severe fetal brain injury with absent multiorgan system dysfunction (MSD) All infants were Dx with hypoxic-ischemic encephalopathy in the neonatal period and went on to have permanent CNS injury. 43% of the 14 cases involved uterine rupture, 36% involved prolonged FHT deceleration and one each cord prolapse, fetal exsanguination and maternal cardia arrest. All infants were later Dx with cerebral palsy. |
| Phelan | Point/Counterpoint: II. The VBAC "Con" game | OGS | 53 | 662 | 1998 | Editorial/Debate with Bruce Flamm. I do not advocate a policy of "once a CS, always a CS" rather that if a VBAC is to be performed, the patient should be better informed. We must understand that fetal brain injury can occur fairly quickly in cases of uterine rupture. Advocates "crash CS drills". The second issue is what to tell the patient of the potential risk of fetal brain damage. According to Dr. Flamm, the use of the phrase "brain damage" would have a chilling effect on the VBAC rate and thwart any efforts to reduce the overall CS rate. Ultimately, the patient needs to be fully informed because it is she and her baby that would undergo the risks. Dr. Flamm may be right about the balanced consent form should not include the phrase about death or permanent brain injury. I would also agree very few people, except managed care organizations, would put a bullet in a 100 chamber revolver, spin the chamber, place the gun against the child's head and pull the trigger. |
| Phelan | Uterine activity patterns in UR: a case control study | OG | 92 | 394 | 1998 | Case control, cases of women with UR during a TOL resulting in a neurologically impaired infant. Controls were a successful VBAC or a vaginal delivery with no PCS. Looked at contraction pattern, tetany and hyperstimulation. Results: 18 ruptures studied. Conclusion: uterine activity patterns and oxytocin use does not appear to be assoc. with the occurrence of intrapartum UR. |
| Roland | Perinatal hypoxic-ischemic thalamic injury: clinical features and neuroimaging | Ann Neuro | 44 | 161 | 1998 | Case reports of 20 newborns with moderate to severe acute hypoxic-ischemic encephalopathy. 16 of the 20 had documented profound hypoxic-ischemic insult by umbilical cord prolapse, uterine rupture or massive placental abruption. |
| Sciscione | Uterine rupture during preinduction cervical ripening with misoprostol in a patient with a previous CS. | Aust NZ JOG | 38 | 96 | 1998 | Case report of uterine rupture in a patient with a previous LTCS, in which transvaginal misoprostol was used for preinduction cervical ripening. |
| Scully | Case Records of the Mass. General Hospital | NEJM | 338 | 821 | 1998 | Case report, previous CS, successful VBAC, immediately developed PPH, manual exploration revealed a uterine rupture, shock. Pt had emergency hysterectomy with transfusion. (minimal blood in the abdomen despite a rent in the right lower uterine wall). Hypotension persisted, cardiac arrest and ultimately unsuccessful resuscitation. Final diagnosis was uterine rupture and amniotic fluid embolus. |
| Shachar | High risk pregnancy outcome by route of delivery | Curr Opin OG | 10 | 447 | 1998 | Review of preferred route of delivery for 3 high-risk pregnancies: multiple pregnancy, VBAC and macrosomic infants of gestational diabetics. The most common feature of all is the lack of information, based on large prospective controlled studies, available to the treating physician for choosing the delivery route. |
| Silberstein | Routine revision of uterine scar after CS: has it ever been necessary? | Eur JOG | 78 | 29 | 1998 | Longitudinal study of 3469 VBAC , all had uterine exploration immediately after delivery. The detection rate of uterine scar dehiscence or rupture was 0.23%. Only one woman with complete uterine rupture needed immediate laparotomy for severe hemorrhage. Conc. the benefit of routine uterine exploration is doubtful. |
| Swaim | Umbilical cord blood pH after PCS. | OG | 92 | 390 | 1998 | Retro, 3 gps, ERCS (n=113), CS after TOL (n=58) and successful VBAC (n=135). Found no sig. differences but "sample size requires other studies. |
| Traynor (Northwestrn) |
Maternal hospital charges assoc. with TOL versus ERCS. | Birth | 25 | 81 | 1998 | Retro, compared costs of TOL with the costs of ERCS. TOL was assoc with a hosp charge of 5820 compared to 6785 for ERCS. |
| West | Woman in labor can withdraw consent for VBAC at any time. Schreiber v. Physicians Insurance Co of Wisc | J health Risk Manag | 18 | 1998 | ||
| Wing | Disruption of prior uterine incision following misoprostol for labor induction in women with PCS | OG | 91 | 828 | 1998 | Case report of disruption of uterine incision found in two of 17 misoprostol Rxed women. The first women underwent a repeat CS at 42 weeks gestation because of fetal tachycardia and repetitive late decels-a 10-cm rent in the anterior myometrium was discovered. The second underwent induction for fetal growth restriction. A loss of fetal heart tones and abnormal abdominal contour prompted emergency CS, a 8-cm longitudinal defect was found. Conc.-when misoprostol is used in women with PCS, there is a high frequency of disruption of prior uterine incision. |
| 1997 | ||||||
|---|---|---|---|---|---|---|
| Author | Title | Journal | vol | pg | yr | Abstract |
| Bennett | UR during induction of labor at term with intravaginal misoprostol | OG | 89 | 832 - 3 | 1997 | Case report, 34 yo multip at 39 weeks gestation. 5 hours after administration of the second 25-microgram dose, fetal bradycardia prompted emergency CS. Hysterectomy and LSO were necessary to control bleeding from a 15-cm posterior uterine wall rupture. |
| Boulvain | TOL after CS in sub-Saharan Africa: a meta-analysis | BJOG | 104 | 1385 | 1997 | Meta-analysis of 17 published reports |
| Bowes | Editorial | OGS | 52 | 69 | 1997 | The problem of VBAC is essentially one of playing the odds. If a pt chooses TOL and is successful, they win-minimal morbidity, short stay and low cost. If VBAC is not successful, they lose: repeat CS after a long labor with increased risk for high morbidity, prolonged stay and high cost. On the other hand, if they choose repeat CS they play a sure thing: low morbidity, slightly longer stay and moderate cost. "I encourage counseling patients about VBAC from a perspective of what is good for the patient rather that what is good for the hospital cesarean section rate." |
| Casanova | Vesico-uterine fistula occurring after a normal labor in a patient with a scarred uterus. | J GynOb Biol Repro | 26 | 637 | 1997 | Case report of vesico-uterine fistula occurring after VBAC. |
| Chapman | One versus 2 layer closure of a low transverse CS: the next pregnancy | OG | 89 | 16 - 8 | 1997 | Prospective, 906 pts. randomly assigned to wither one or two layer closure. 164 had subsequent pregnancy and delivery. The demographics were similar for one and two layer closure |
| Dilke | Role of self-efficacy in birth choice | J Perinat Neonat Nurs | 11 | 1- 9 | 1997 | 74 pregnant women completed a self-administered questionnaire. Results found that women choosing ERCS had lower self-efficacy scores suggesting the need for further research. |
| Dyack | VBAC in the grand multiparas following previous LTCS. | JOG Res | 23 | 219 | 1997 | Retro., 5 year period, eval. pts. with 6 or more previous deliveries and with a PCS were identified. 85 women with combo of grandmultiparity and a PCS scar were found. 45 attempted TOL, 27 (60%) were successful. There was a relatively high incid of serious complications. Conc.-VBAC can be achieved in some grand multiparas with a PCS. There is an increased risk of serious complications The labor should be closely supervised and early intervention arranged if there is not smooth rapid progress. |
| Fla. Agency for Health Care Admin. | VBAC rate reflects the % of women who have a vaginal birth after having a baby by cesarean. | The Miami Herald | 1997 | %VBAC 1990 92 94 95 Dade Co. 22.5 23.5 29.2 28.6 Florida 23.3 27.7 33.5 34.6 %C-Section rate 90 91 92 93 94 95(est) 96(est) U.S. 23.5 23.5 23.5 22.8 22 20.8 20.6 Florida 26.5 25.2 25.1 24 23 22.8 22.7 |
||
| Flamm | Once a CS, always a controversy. | OG | 90 | 312 - 5 | 1997 | In the 1980s VBAC grew in popularity and the pendulum began to swing away from routine ERCS. Recently the wisdom of this transition has been questioned. As the 20th century comes to a close, the treatment of the patient with PCS remains controversial. |
| Flamm | Prostaglandin E2 for cervical ripening: a multicenter study of patients with PCS. | Am J Peri | 14 | 157 - 60 | 1997 | Starting in 1990, all pts. with PCS were eval. at 10 California hospitals. 5022 pts., 453 (9%) received PGE2 gel. There ws no sig difference in the incid of UR between the {GE2 gp and the controls. Indicators of maternal and perinatal morbidity were not sig higher in the PGE2 gp. The use of PGE2 gel for cervical ripening appears to be relatively safe in pts. with PCS. |
| Fraser | Randomized controlled trial of a prenatal VBAC education and support program. Childbirth alternatives post - cesarean study group | AJOG | 176 | 419 | 1997 | Assess whether a prenatal education program increases success of VBAC. Measured motivation and separated into 2 gps: one given individual instruction and the other given pamphlet. Conc.-there were no sig differences between the individualized instruction group and the brochure group. |
| Guleria | Pattern of cervical dilatation in previous lower segment CS pts. | Jindian Med Assoc | 95 | 131 | 1997 | 100 pts. attempting VBAC prospectively studied with partograph. The mean initial dilatation rate (IDR) and average dilatation rate (ADR) for those successful (84 patients) was 0.88 cm/hour and 1.26 cm/hour respectively. The IDR for those requiring CS was 0.44 cm/hr and the ADR was 0.42 cm/hour. Hence, ADR in cases who required repeat CS was significantly slower. |
| Harrington | VBAC in a hospital-based birth center staffed by certified nurse-midwives. | J Nurse Midwifery | 42 | 304 - 7 | 1997 | Retro., 303 pts. with PCS undergoing TOL compared with control gp. Intrapartum transfer for medical management was necessary in 26 study patients (8.7%) and in 10.4% of controls. The overall rate of VBAC was 98.3 ws not sig different from controls vaginal rate of 99.3%. (There was a high percentage of prior vaginal deliveries along with history of PCS in study group). Conc.-in selected, low-risk patients with PCS, a TOL may be managed safely and effectively by certified nurse midwife in a hospital setting. |
| Holt | Attempt and success rates for VBAC in relation to complications of the previous pregnancy. | Paediatr Perinat Epi | 11 sup |
63 | 1997 | Looked at first-born CS and second liveborn (n=10,110). Overall, 64% of the cohort attempted VBAC and 62% of those were successful.(overall VBAC rate of 40%). Women with fetal macrosomia, CPD, prolonged labor, diabetes or placental problems in the first pregnancy were less likely to attempt TOL. Women with hx of induced labor, herpes, fetal distress or breech presentation in first pregnancy were more likely to attempt VBAC. Approx. _ of women with prior macrosomia, labor problems and chromic medical conditions succeeded in VBAC. Approx. _ of pts. with previous breech or placental problems succeeded. |
| Hook (Case Western) |
Neonatal morbidity after ERCS and TOL. | Pediatrics | 100 | 348 - 53 | 1997 | Retro. All mothers who underwent PCS and delivered singleton infants at term were identified. Neonatal outcomes were compared between infants delivered by ERCS (#497) and those delivered by TOL (#492). Also compared were those successful with TOL (#336) and failed TOL (#156). A cohort of routine vaginal delivery was identified also. Results: Infants delivered by ERCS had an increased rate of transient tachypnea compared with TOL. Compared with routine delivery the odds ratio of transient tachypnea was 2.6. In addition, 2 infants delivered by ERCS had RDS. Infants delivered after TOL had an increased rate of suspected and proven sepsis (5% suspected for TOL vs 2% for ERCS, 1% proven sepsis for TOL vs 0.1% proven sepsis for ERCS). Compared with successful TOL, infants of failed TOL had more neonatal morbidity and had a longer hosp. stay. The odds ratio of developing respiratory illness after failed TOL was 2.1, for suspected sepsis was 4.8 and for proven sepsis was 19.3. Conc. Infants born by ERCS are at increased risk for developing respiratory problems. TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to those infants delivered by CS after failed TOL. |
| Hoskins | Correlation between maximum cervical dilatation at CS and subsequent VBAC. | OG | 89 | 591 - 3 | 1997 | retro., compared indications for CS and dilatation at time of CS with success rate at VBAC, 1917 pts. Indications for initial CS=malpresenatation-5.1%, fetal distress-14.9% and arrest disorders-80%. Success rates for VBAC were: Malpresentation-73%, fetal distress-68%. Arrest disorders with dilatation at time of CS 5 cm or less=67%, 6-9 cm dilated 73% but only 13% if pt fully dilated at time of PCS. Conc.-pts. who attempt VBAC may be counseled that PCS at full dilatation is association with a reduced chance of success. |
| Kattan | Maternal urological injuries associated with vaginal deliveries: change of pattern | Int Uro Nephrol | 29 | 155 - 61 | 1997 | Retro. With recent introduction of VBAC the pattern of maternal urological injuries associated with vaginal deliveries have changed. 7 females with vaginal delivery had major urologic injury 1992-1994, 4 of which have history of PCS. These included rupture of the posterior bladder wall, trigone and bladder neck. Distal ureteric and urethral injuries as well as bladder contusion were also encountered. 2 patients developed vesico-uterine and vesico-vaginal fistulas. The presence of gross hematuria, incontinence and flank pain should indicate full urological evaluation. |
| Longo | Consumer reports in health care. Do they make a difference in patient care? | JAMA | 278 | 1579 | 1997 | Retro. of hospital behavior using both primary survey and secondary clinical data by Missouri Dept. of Health about reports to the consumer. Reports were issued in 1993 to all Missouri hospitals providing OB care (90). Examined change in hospital care provided by clinical outcomes including VBACs. Conclusion: public release of consumer reports may be useful not only in assisting consumers but also in facilitation improvement in the quality of hosp. services offered and care provided. |
| Martin | The case for TOL in the patient with a prior LVCS. | AJOG | 177 | 144 | 1997 | Review of recent OB literature, 10 studies included information about LVCS were included, 372 pts., 306 (82%) of which had a successful VBAC. 4 UR occurred (1.05%). Conc.-the patient with one prev non-extended low vertical CS should be considered as a candidate for VBAC. "The same care, counseling and caution should be exercised for this patient as for one with a prior LTCS". |
| Miller | Intrapartum UR of the unscarred uterus. | OG | 89 | 671 - 3 | 1997 | LAC-USC, 13 cases of UR in unscarred uterus, 3 from motor vehicle accidents. The incid of UR in an unscarred uterus was 1:16,849 deliveries. Association. factors: 4 cases used Pitocin, 3 used prostaglandin, 3 cases used vacuum assisted delivery, 2 cases of grandmultiparity and 2 cases of malpresentation. Intervention was prompted by fetal bradycardia in 7 and hemorrhage in 3. Six patients had severe abdominal pain, 5 had maternal tachycardia and 2 had severe hypotension. Neonatal outcomes were normal in 9. |
| Odeh | Evidence that women with a history of CS can deliver twins safely | Acta OG Scand | 76 | 663 | 1997 | Retro. of all twins gestations 1970-1993, 36 were eligible for study, 25 were allowed a TOL. 80.9% delivered vaginally and 19.1% had CS. Hospitalization was 4.4 days versus 8.0 days for ERCS. Transfusions were 9.5% versus 26.6% (TOL versus ERCS) Infections were 9.5 versus 46.6. there was no scar dehiscence. Conc.-vaginal delivery of twins after one PCS may be considered in appropriate cases. |
| Paterson (London) |
Caesarian section: every woman's right to choose? | Cur Opin OG | 9 | 351 | 1997 | Until recently, doctors and patients have been united in wanting lower CS rates. This is changing and the concept of a more liberal patient-centered choice is gaining credence. CS are no longer black and white decisions, but are becoming increasingly discretionary, based on maternal choice, their increasing safety for the mother and baby, and recognition of the pelvic damage associated with vaginal birth. |
| Perveen | Obstetrical outcome after one PCS. | JOG Res | 23 | 341 | 1997 | Prospective study of TOL after one PCS. A total of 2,447 deliveries of which 167 had one PCS. 112 (67%) had TOL and 72 (64%) were successful. The success would be much higher if a fixed protocol could be applied to all the patients. 46% of pts. with past indication of CPD delivered vaginally. |
| Philippe | Transvaginal surgery for uterine scar dehiscence. | Eur JOG Repro Bio | 73 | 135 - 8 | 1997 | Proposal of a transvaginal technique for suturing a dehiscence. |
| Roberts | TOL or repeat CS . The woman's choice | Arch Fam Med | 6 | 120 | 1997 | MEDLINE search, data extracted from 292 article. Maternal outcomes showed TOL increased the risk of UR, ERCS increased the risk for infection and bleeding. Infant outcomes differed only for 5 minutes Apgar scores of less than 7, which were more likely for TOL. Costs were 1.7 to 2.4 times > for ERCS. Conc.-a woman should be given information on both delivery methods and encouraged to undergo TOL but her preference for ERCS should be respected. |
| Rowbottom | UR and epidural analgesia during TOL | Anaesthesia | 52 | 486 | 1997 | Case report of UR in a pt with epidural. The pain of UR was not masked by the addition of fentanyl 25 micrograms to bupivacaine 0.25% but was relieved by bupivacaine 0.375% 6 ml. |
| Schimmel | Toward lower CS rates and effective care 5 years outcomes of joint private OB practice | Birth | 24 | 181 | 1997 | Statistical analysis of a joint obstetrical practice in California, 1991-95, 1303 consecutive deliveries, Primary CS rate of 6.5%, total rate of 9.1%. 72% of patients with a PCS delivered vaginally, success rate for attempted VBAC was 83.5%. Instrumental deliveries happened in 2% and third/fourth degree lacerations in 1.3%. |
| Schuitemaker | Maternal Mortality after CS in The Netherlands | Acta OG Scand | 76 | 332 | 1997 | Nationwide confidential enquiry into the causes of maternal death. The risk of dying from a vaginal delivery was 0.04/1000 vaginal births versus a direct risk from CS of 0.13/1000 CS. |
| Scott | Avoiding labor problems during VBAC | ClinOG | 40 | 533 | 1997 | Review article, Quotes uterine rupture rate as follows: classical scar or t-incision 4-9%, low vertical incision 1-7%, LTCS 0.2-1.5%. The rate of repeat rupture is 6% if rupture was in lower uterine seg, if scar included upper segment of the uterus the rate of repeat rupture was 32%. |
| Sieck | VBAC: a comparison of rural and metropolitan rates in Oklahoma | J Okla St Med Assoc | 8 | 444 | 1997 | Retro compared VBAC in rural and urban settings. Urban rate of TOL was 46% with success of 36% compared with rural of 30%TOL and 18% success. |
| Spaans | TOL after PCS in rural Zimbabwe | EJOGRB | 72 | 9 | 1997 | Case control, 281 pts. with PCS attempting VBAC. No ERCS were performed, 44% were successful in VBAC, one UR occurred. Perinatal and maternal outcome did not differ between cases and controls. A hx of multiple PCS and CS for CPD increased the risk for a repeat CS. Conc.-a policy to allow all women a TOL after PCS did not inc adverse pregnancy outcome. |
| Stalnaker | Characteristics of successful claims for payment by the Florida Neurologic Injury Compensation Association Fund | AJOG | 177 | 268 - 71 | 1997 | The Florida Birth related Neurological Injury Compensation is a no-fault alternative to litigation for catastrophic neuro. birth injury. 64 cases reported on. 45 were delivered by CS and 15 of the 19 vaginal deliveries were operative. A persistent nonreassuring fetal heart rate tracing was seen in all. The 5 minute Apgar score was < = 6 in 91% and the 10 minute was <= 6 in 86%. 17 women presented to L+D with a nonreassuring pattern. Nine attempts at VBAC led to a uterine rupture, 7 of which were either inductions or augmentations against an unfavorable cervix. 45% of deliveries were associated with MSAF. there were 3 shoulder dystocias and 4 infants with group B strep. In 8 cases (12.5%) there appeared to be a breach of published standard of care. |
| Turner | Delivery after one previous CS | AJOG | 176 | 741 | 1997 | Historical, incid of Cesarean Section has inc from 1:20 in 1970 to 1:4. Elective repeat Cesarean Section has been a major contributor to that inc. Cragins "rule" (New York Medical Journal 1916) of once a Cesarean Section always a Cesarean Section was during a time when a classical incision was made. It was in 1921 that Kerr and Holland recommended the use of transverse. Management in Dubin-accurate US determination of age and placenta localization. Avoid induction if possible, EFM but do not use IUPC, epidurals all right, OCYTOCIN IS USED WITH EXTREME CAUTION BECAUSE OF CONCERN OF RUPTURE OF UTERUS. The single most important predictor of success is previous vaginal delivery. Even in a modern OB unit, rupture is assoc with significant maternal and fetal mortality and morbidity including transfusion and hysterectomy. 10 year review at Coombe hospital in Dublin, 65,488 deliveries, 15 cases or uterine rupture. 13 of 15 ruptures occurred in multigravidas with previous Cesarean Section. 10 of 15 HAD LABOR INDUCED AND 13 PTS. RECEIVED PITOCIN. In contrast, Pitocin enhancement of spon labor is rarely assoc. with rupture. |
| Unuroa | Major injuries to the urinary tract in associated. with childbirth | East Afr Med J | 74 | 523 | 1997 | Retro., 48,693 deliveries, 4622 CS giving a CS rate of 9.5%.. Of 10 cases of severe bladder injuries, 7 occurred in assoc. with ruptured uteri and 3 at repeat CS. |
| 1996 | ||||||
|---|---|---|---|---|---|---|
| Author | Title | Journal | vol | pg | yr | Abstract |
| Adair | TOL in patients with a previous lower uterine vertical CS | AJOG | 174 | 966 - 70 | 1996 | Retro, U of Fla., 77 pts with prior LVCS, 14.3% had repeat CS compared with 9% of the controls. One pt in the PCS gp had a uterine rupture. Conclusion: a TOL in women with previous low vertical CS results in an acceptable rate of vaginal delivery and appears safe for both the mother and baby. |
| Bickell | Effect of external peer review on CS rates: a statewide program | OG | 87 | 664 | 1996 | NY, 45 of 165 active delivery services were reviewed. Conc.: this joint specialty society and health dept. peer review had no apparent impact on CS rates. |
| Catanzarite | US Dx of traumatic and later recurrent UR. | A J Peri | 13 | 177 | 1996 | Case report of traumatic transverse fundal UR with fetal death followed by recurrent rupture during the subsequent (twins) pregnancy. UR was sonographically Dx after an auto accident. UR was again Dx sono. based on the extrusion of the BOW through the uterine incision without fetal distress. Emergency CS was done with good outcome. |
| Chervenak | An ethically justified algorithm for offering, recommending and performing CS and its application in managed care practice. | OG | 87 | 302 | 1996 | Ethical discussion about CS, etc and what to offer the patient under what circumstances. |
| Chin | UR during labour in a primigravid | Aust NZ JOG | 36 | 210 - 2 | 1996 | Case report of incomplete UR in a primigravid who had no previous instrumentation to the genital tract. UR manifested by fetal bradycardia. |
| Clark | State variation in rates | Stat Bul Metrop Insur Co | 77 | 28 | 1996 | There is wide variation among states in rates of CS and VBAC. In general, the south has the highest CS rate and the west the lowest. Louisiana had highest CS rate of 27.7% in 1993 and Alaska the lowest with 15.2%. Louisiana had the highest primary rate of 19.6 and Wisconsin lowest at 10.6. Most states had a substantial inc in VBAC rates. CS rates were lowest for mothers under 25 having second birth in Alaska and highest for mothers >35 having their first child in Mississippi. |
| Davies | VBAC: physicians' perceptions and practice | JRM | 41 | 515 | 1996 | Chart review, found that if all pts. who were appropriate for VBAC attempted same, their hosp. CS rate would have dropped from 14.9 to 13.5%. "All patients eligible for a TOL should be strongly encouraged to do so regardless of their previous indication for CS." |
| Goodlin | Anterior vaginotomy: abdominal delivery without a uterine incision | OG | 88 | 467 | 1996 | 13 anterior vaginotomies were done when the vagina had advanced during prolonged second stage. The procedure appears safe, although one pt had a postpartum bladder flap hematoma and one had gross hematuria. 3 had pp. endometritis and one required a blood transfusion. "requires further study" |
| Grubb | Latent labor with an unknown uterine scar | OG | 88 | 351 | 1996 | Term mothers with hx of one or more PCS with unknown scar in early labor were randomized to nonintervention (discharged after 4 hours of no change in Cx) 101 and intervention (admitted, contractions that persisted for 4 hours without change were augmented with Pitocin) -96 patients. Results: Intervention had a statis. sig. higher rate of uterine scar separation (5 versus 0%). There were no diff. in length of active labor or incid of CS (16 versus 17%). conc.- the augmentation of ineffective contractions in latent labor does not inc the rate of CS but it is more likely to result in scar separations. |
| Kildea | Trial of scar-team midwifery makes a difference | J Aust Coll Midwives | 9:3 | 21 - 2 | 1996 | Case report of two PCS pts. (one with 2 PCS and the other with 3 PCS), one had twins. Physicians were not amenable to VBAC, certified nurse midwives were and delivered them. |
| Lagrew | Decreasing the CS rate in a private hospital: success without mandated clinical changes | AJOG | 174 | 184 | 1996 | Retro, deliveries 1988-94. Instituted a program of increasing awareness, confidential provider feedback and more aggressive laboring techniques. Results overall CS rate fell from 31.1% to 15.4%, primary fell 17.9% to 9.8%. The drop in repeat CS rate was accounted by an increase VBAC. |
| Lau | A study of patients' acceptance towards VBAC | Aust NZ JOG | 36 | 155 | 1996 | 99 pts. with PCS. Only 53% would accept VBAC if told that chance of success was 70%. A history of vaginal delivery and negative feelings towards previous operation were positively associated with acceptance ot VBAC. Convenience of ERCS and fear of vaginal delivery were the commonest reasons for refusal. |
| Learman | Predictors of repeat CS after TOL: do any exist? | JACS | 182 | 257 | 1996 | LAC-USC, 175 consecutive pts who underwent TOL, 85% delivered vaginally, Pts who had labor included and pts with high fetal station on admission were sig. more likely to require repeat CS (67% and 75% respectively) A subgroup of induction and macrosomia only had 25% successful VBAC. Conc.= until risk factors with high predictive value for repeat CS are identified, all eligible pts should be encouraged to undergo a TOL. |
| Lynch | UR and scar dehiscence. A 5-year survey. | Anes Intestive Care | 6 | 699 - 704 | 1996 | 27 cases of UR reported out of 31,115 deliveries for an incid of .086%. there were no maternal deaths but fetal mortality occurred in 5 of the 27. |
| Martins | VBAC | Clin Perinat | 23 | 141 | 1996 | The VBAC rate continues to rise due to both national organization recommendations and trials spanning 10 years. Broadening eligibility criteria and investig. factors influencing the rate should place us on the glide path to reduction of the overall CS rate by 2000. |
| Mathelier | Radiopelvimetry after CS. | JRM | 41 | 427 - 30 | 1996 | 70 postpartum pts. who had CS (various indications), got radiopelvimetry before discharge. The pelvis was considered adequate in 45.7% and inadequate in 54.2%. |
| McMahon | Comparison of TOL with an elective second cesarean section | NEJM | 335 | 689 | 1996 | Population based longitudinal study of 6138 women in Nova Scotia with hx of PCS and delivered another child. The relevant issue is not risks of successful vaginal birth after CS but the risks of TOL. A total of 3249 underwent TOL and 2889 had an elective CS (of the TOL group, 1030 had a previous vaginal delivery, either before or after PCS). There were no maternal deaths. The overall rate of maternal morbidity was 8.1% (1.3% major-hysterectomy, UR or operative injury, 6.9% minor-fever, blood transfusion or abdominal-wound infection). The overall rate did not differ sig., major complications were nearly twice as likely among women undergoing a TOL. Conc.-among preg. women with PCS, major maternal complication are twice as likely among those whose deliveries are managed with a TOL as among those who have elective CS. |
| Miller | Declining CS rates: a continuing trend? | Health Reo | 8:1 | 17 - 24 | 1996 | Canada, A major factor in the downturn of CS rates has been a steady increased in VBAC. From 1979 to 1993 the VBAC rte rose from 3 to 33%. In 1993, the CS rate ranged from 15% in Manitoba to 22% in New Brunswick. The VBAC rate ranged from 16% in New Brunswick to 42% in Alberta. |
| Miller (LACUSC) |
VBAC in twin gestation | AJOG | 175 | 194 | 1996 | Retro., 210 sets of twins with hx of PCS, 44 attempted TOL with no increase in maternal or perinatal morbidity or mortality. |
| Ouzounian | Amnioinfusion in women with PCS: a preliminary report | AJOG | 174 | 783 - 6 | 1996 | Retro review, 936 women had amnioinfusion for oligo., MSAF and variable decelerations. Of these, 122 had PCS. Conc: amnioinfusion is safe in PCS. |
| Paul (LAC-USC) |
Editorial: Toward fewer cesareans sections --the role of a trial of labor | NEJM | 335 | 735 | 1996 | Editorial to McMahon article in NEJM 335:889, 1996. |
| Phalen | Uterine activity patterns in UR patients: a case control study (abst) | AJOG | 174 | 358 | 1996 | |
| Phelan | VBAC: Time to Reconsider? | OBG Management | 62 | 1996 | Editorial article about risks of VBAC, case report of successful litigation about lack of consent for VBAC and complications. Suggested VBAC consent form outlined. Issues commonly raised in uterine rupture lawsuits: informed consent, Pitocin use, CS indicated prior to UR (labor curve, FHT pattern), Dx of UR (maternal and/or fetal Sx) and managed care environment. Proposed causes of UR: type of incision, Pitocin, labor and placenta. | |
| Porreco | The Cesarean Birth Epidemic: Trends, Causes, and Solutions | AJOG | 175 | 369 - 374 | 1996 | |
| Robson | Using the medical audit cycle to reduce CS rate | AJOG | 174 | 199 | 1996 | Retro., of all deliveries 1984-1988, developed strategies for labor management directed at the primary indication for CS (dystocia). The effect of strategies were then prospectively studied 1989-92. 21,125 deliveries were studied. After management change the overall CS rate was decreased from 12 to 9.5%. Applying principles of early Dx and Rx of dystocia resulted in a decrease in the CS for dystocia (7.5-2.4%). |
| Rooney | Is a 12% CS rate at a perinatal center safe? | J Perinat | 16 | 215 - 9 | 1996 | 10 years of deliveries 1983-1992 and 5 years of mortality and morbidity 88-92 were compared with national statistics. the CS rate was on avg. 12.5%, the forceps and VAD were consistently less than 5%. The nurse midwife service delivered approximately 36%. Conc.- the lowest safe CS rate is not known; it will undoubtedly vary with location and patient mix. Our rate has been accomplished through a vigorous prenatal care program. excellent perinatal and infertility services, a vigorous program of VBAC and a competent nurse-midwifery service. |
| Rozenberg | US measurements of LUS to assess risk of defects of scarred uterus | Lancet | 347 | 281 | 1996 | Prospective observational, 642 pts with PCS had US at 36-38 wks separated into 4 gps on basis of LUS thickness. Overall freq. of defective scars was 4% (15 UR, 10 dehiscences). The freq. of defects rose as thickness decreased. No defects if thickness was 4.5 mm, 2% with thickness 3.6-4.5, 10% with values 2.6-3.5 and 16% when thickness was 1.5-2.5. Conc-in hosp where repeat CS is norm, encourage TOL with thickness 3.5 or greater. |
| Soltan | Pregnancy following rupture of the pregnant uterus | IJOG | 52 | 37 | 1996 | Retro review found 11 cases of ruptured uterus, 6 of whom occurred in pts with previous ruptured uterus. 2 patient were primigravids, fetal heart rate abnormalities were observed in all the UR in labor. |
| Suner | Fatal spontaneous rupture of a gravid uterus: case report and literature review of UR | J Emerg Med | 14 | 181 | 1996 | Case report of UR, 38 y.o. gravid presented to ER in cardiac arrest 24 hours after an initial complaint of abdominal pain. |
| Weinstein | Predictive score for VBAC | AJOG | 174 | 192 | 1996 | Retro, 10 year, VBAC after one PCS. 368 (78.1%) attempting VBAC were successful and 21.9% had repeat CS. Pos. predictors were malpresentation, PIH, Bishop score < 4. Hx of CPD and FTP did not demonstrate predictive value (63.8% with those Dx were successful). Macrosomia and IUGR tended to decrease the chances of VBAC. |
| Weinstein | VBAC: current opinion | IJGO | 53 | 1 | 1996 | Current literature attests to the merit of TOL. Some controversies remain: can women with 2 or more CS undergo TOL, or prostaglandins for induction. |
| Zisow | UR as a cause of shoulder dystocia | OG | 87 | 818 | 1996 | Case report, G4P2 adm for labor induction. FHT normal until full dilation when fetal bradycardia developed and persisted until delivery. With the use of forceps, vtx delivered but head retraction was encountered, attempts at delivery unsuccessful requiring a CS. Findings were body anterior to the already contracted, anterolaterally ruptured uterus. An abdominally assisted vaginal delivery was accomplished. |
| Zorlu | Vaginal birth following unmonitored labor in pts. with PCS. | Gyn OB Invest | 42 | 222 - 6 | 1996 | Retro., 165 pts. with PCS who delayed coming to the hospital were reviewed. 71 were allowed to continue to labor and 62 were successful. The overall rate of scar separation was 3.6% Other than scar separation and febrile morbidity, no maternal morbidity was observed. 98.4% of infants has 5 minute Apgar scores of >= 7. |
| 1995 | ||||||
|---|---|---|---|---|---|---|
| Author | Title | Journal | vol | pg | yr | Abstract |
| AAFP Task | TOL vs. elective repeat CS | AFP | 52 | 1763 | 1995 | Meta analysis, about 70% of TOL can expect success. TOL was assoc. with a sl. inc risk of UR (0.24%) and a dec. risk of infection and fever and postpartum bleeding. Financial cost of CS was 1.66 to 2.4 greater than the cost of TOL. http://www.aafp.org/family/pracguid/vbac.html |
| ACOG | Fetal Heart Rate Patterns: Monitoring, Interpretation, and Management | ACOG Comm. Op. | 207 | 1995 | FHR evaluation should be provided for all patients in labor to detect complications resulting from alterations in fetal oxygenation. | |
| ACOG | Induction of Labor | ACOG Comm. Op. | 217 | 1995 | (replaces #157) | |
| Adair | A TOL complicated by UR following amnioinfusion | SMJ | 88 | 847 | 1995 | Case report of UR following amnioinfusion in a TOL. "Demonstrates the need for careful attention to amnioinfusion volumes and administration." |
| Adair (U of Fla. Jacksonville) |
Labor induction in pts with PCS | AJ Peri | 12 | 450 | 1995 | Retro, all pts with PCS requiring Pitocin, 160 pts, 69% had VBAC. Women with hx of PCS had a higher incid of operative vaginal del, prolonged first and second stages, rate and maximum dose of oxytocin infusion. There was one UR. "Labor induction with PCS results in an acceptable rate of vaginal del and appears safe for both mother and fetus." |
| Asakura | More than one PCS: a 5 year experience with 435 pts | OG | 85 | 924 - 929 | 1995 | Record review of 435 pts with > 1 PCS compared with 1206 pts with one PCS. Uterine wound separation occurred in 9/435 versus 16/1206 (not sig.). VBAC was less successful with more than one PCS (64% versus 77%). Important adverse outcomes were infrequent and not related to the number of PCS. |
| Burns | The effect of physician factors on the CS decision | MedCare | 33 | 365 - 82 | 1995 | Patient factors appear much more important than both physician and hospital factors. |
| Chen | a 10-year review of UR in modern OB practice. | Ann Acad Med Singapore | 6 | 830 - 5 | 1995 | Retro., 26 cases of proven UR. Clinical presentations included abnormal FHT (25%), bloody amniotic fluid (20%) for pts. with a scarred uterus. Those with an unscarred uterus presented with postpartum hemorrhage (50%) and shock (33%). there was one maternal death (3.8%) and the overall incid of fetal loss was 7.4%. |
| Chez | Cx ripening and labor induction after PCS. | COG | 38 | 287 | 1995 | Preponderance of data indicates that: 1. If there is no contra to spon cx ripening there is no contra to use of prostag. gel or tents. 2. If there is no contra to spon labor, there is no contra to the use of oxytocin in pts with PCS. |
| Clarke | Changes in CS in the US 1988 and 1993 | Birth | 22 | 63 - 7 | 1995 | CS rate for 1993 in the US was 22.8% with a primary rate of 16.3%, which was stable during 88-93. The VBAC rate doubled from 12.6% to 25.4%. Even if VBAC rates increase at the same rate as in the past, the goal of CS rate of 15% by 2000 will no be met without reducing primary rate by 50%. |
| Gates | Think globally, act locally: an approach to implementation of clinical practice guidelines | Jt Comm J Qual Improv | 21 | 71 - 84 | 1995 | 7-step process for implementing CQI-continuous quality improvement as applied to VBAC. |
| Hamrick - Turner | Gravid UR: MR findings | Abd Imag | 20 | 486 | 1995 | Case report of MR of uterine dehiscence. |
| Khan | The partograph in the management of labor following PCS | IJOG | 50 | 151 | 1995 | 236 pts attempting VBAC, a 1 cm/hr line was use to indicate an alert line on the partogram. There were 5 time zones-A=area to the left of alert line, B=0-1 hr after alert line, C=1-2 hr after line, D=2-3 hrs after alert line and E and F=>3 hrs. 55 pts ended with repeat emergency CS (23%) with 7 (2.3%) UR. Of the 181 successful VBAC, 83% occurred within 2 hr after the progress of labor had crossed the alert line (zones A-C). Conc-in women attempting VBAC, the partographic zone 2-3 hr after the alert line represents a time of high risk of UR. |
| Markos | Ultrasonographic Dx of uterine rent at 33 weeks gest | AJOG | 172 | 224 - 6 | 1995 | Case report, Hx of uncomplicated D+C for incomplete was seen at 33 weeks gestation c/o decreased fetal movement and intermittent abdominal pain for one week. US demonstrated oligohydramnios and a fundal uterine rent continuous with a large fluid-filled cystic mass. Laparotomy revealed a R cornual uterine rent with hourglass amniotic sac. A healthy infant was delivered by CS. |
| Miklos | Vesicouterine fistula: a rare complication of VBAC | OGsup | 86 | 638 | 1995 | Case report of pt who developed vesicouterine fistula during delivery after PCS. An anterior uterine wall defect was noted immed after the delivery, continuous bladder drainage was unsuccessful. and surgical correction was necessary. |
| Miller | VBAC: a 5-year experience in a family practice residency program. | Jam Brd FP | 8 | 357 | 1995 | National objective for CS rate is 15% overall with a primary rate of 12% and a VBAC rate of 35%. In 1991 the overall rate nationally was 23.5%, 17% and 24.2% respectively. Retro study of 996 fam. practice deliveries, 98 had PCS with 87 eligible for TOL, 64% accepted a TOL with 77% success. |
| MMWR | Rates of CS--US 1993 | MMWR Morb Mort Wkly Rpt | 44 | 303 - 7 | 1995 | |
| Naef | TOL after CS with a lower-segment, vertical uterine incision: is it safe? | AJOG | 172 | 1666 - 74 | 1995 | 10 year period, all lower segment CS (whether LT or LV) were considered appropriate for VBAC attempt. 1137 pts had LVCS, 262 were subsequently delivered of 322 live born infants (174 or 54% attempted VBAC and 83% of them were successful-144 of 174)PPH occurred more often in the TOL gp but there was more endometritis in the repeat CS gp. There were 2 uterine ruptures (1.1%) in the TOL gp and none in the repeat CS gp. Neither mother experienced fetal extrusion or adverse outcome for mother or baby. Conc-prior LVCS can undertake a TOL with relative maternal-perinatal safety with risks comparable to those of previous LTCS. |
| Paul | CS: how to reduce the rate | AJOG | 172 | 1903 - 11 | 1995 | LAC-USC CS rate peaked at 25% and is now in modest decline. Target rate is 15% by 2000 with 13% primary and 3% repeat. Major indications for CS are prev. CS-8%, dystocia-7%, breech-4%, and fetal distress 2-3%. The major areas of reduction must occur in the PCS and dystocia. An expanded TOL and VBAC will produce further reductions (Europe has a 50% VBAC rate versus 25% in US) Even if a 50% VBAC rate occurs, the national goals are unachievable. |
| Saglamtas | Rupture of the uterus | IJOG | 49 | 9 | 1995 | Birth records of 58,262 deliveries examined for years 1990-92. There were 40 ruptures for a frequency of .068% (1/1457). 30 had previous CS. Fetal mortality was 32.5% and no maternal deaths were reported. |
| Segal | Eval. of breast stim. for induction of labor in women with a PCS and in grand multiparas | Acta OG Scand | 74 | 40 - 1 | 1995 | Retro., from 135 pts in who labor was induced with breast stim (PCS and grandmultips). Success rate in achieving vag. del. was 84%. Conc-breast stim. is efficacious and safe. |
| Sweeten | Spontaneous rupture of the unscarred uterus | AJOG | 172 | 1851 - 56 | 1995 | Case report of 2 uterine ruptures in a previously unscarred uterus. Both received low dose Pitocin, bradycardia and uterine hyperstimulation occurred at onset of second stage of labor. |
| Thorp | The Effect Of Maternal Oxygen Administration During The Second Stage Of Labor On Umbilical Cord Gas Values: A Randomized Controlled Prospective Trial | AJOG | Feb | 465 - 474 | 1995 | Maternal oxygen administration > 10 min. resulted in deterioration of cord blood gas values at birth. |
| van Alphen | Recurrent UR Dx by US | USOG | 5 | 419 | 1995 | Case report of recurrent UR. Pt had hx of left cornual uterine rupture which was repaired. US during subsequent pregnancy showed no signs of dehiscence until pt presented with Sx. US at that time revealed protrusion of the membranes at the fundus. |
| van Roosmalen | CS birth rates worldwide. A search for determinants | Trop Georg Med | 47 | 19 - 22 | 1995 | |
| Videla (Lackland AFB - Hankins) |
TOL: a disciplined approach to labor management resulting in a high rate of vag. del. | AJPeri | 12 | 181 | 1995 | Overall CS rate at their institution was 9%. Labor management inc encouragement of TOL, Pitocin when indicated, epidural analgesia only after entering the active phase and continuous fetal monitoring. 713 pts had PCS, 588 attempted TOL and 517 (88%) were successful. 4 UR occurred, one received Pitocin. |
| Williams Seattle |
Preinduction prostaglandin E2 gel prior to induction of labor in women with PCS. | Gyn Ob Invest | 40 | 89 | 1995 | Retro cohort compared 117 women with one PCS with control. Received 0.5 mg of intracervical prostaglandin E2. Overall VBAC had a higher CS rate as compared with control. Overall, the efficacy and safety is comparable to that observed in nulliparas. |
We have honestly attempted to record everything accurately, however, please refer to original article for any major decisions pertaining to patient care. Keywords for search:Vaginal Birth After CS, Cesarean Section, Uterine Rupture, Trial of Labor Philip J. Rosenow, M.D. Please send additions, corrections, problems or missing abstracts to: Ken Turkowski. turk "at" worldserver "dot" com Maintained at http://www.worldserver.com/turk/birthing/rrvbac.html. last revised:
2046 Stuart Court
Burlington, NC 27215-4500
philip "at" netpath "dot" net