Repeat cesarean section and primary elective cesarean section: recently trained obstetrician-gynecologist practice patterns and opinions.
ABSTRACT This study was undertaken to determine opinions of obstetrician-gynecologists regarding vaginal birth after cesarean (VBAC) section and elective cesarean section.
A questionnaire was administered to obstetrician-gynecologists attending 2 review courses.
Of 500 obstetrician-gynecologists, 304 completed the survey for a response rate of 61%. Most (92%) counseled VBAC candidates differently, and 84% quoted differential VBAC completion rates on the basis of the indication for prior cesarean section. Uterine rupture was virtually always discussed (99%). Pelvic floor risks were infrequently discussed with urinary incontinence, pelvic organ prolapse, and fecal incontinence discussed by less than one third of obstetricians (30%, 28%, and 25%, respectively). Fifty-nine percent of physicians would perform a primary elective cesarean section, and 67% would perform a primary elective cesarean section specifically to prevent pelvic floor disorders.
Two thirds of recent graduates are willing to perform an elective cesarean section to prevent pelvic floor injury. Most offer VBAC; however, less than a third include risk of pelvic floor injury in their informed consent discussions.
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ABSTRACT: The formula χ=3μ−3b+5νχ=3μ−3b+5ν in Corollary 2.2 in [Hernández, X., Miret, J., Xambó, S., 2007. Computing the characteristic numbers of the variety of nodal plane cubics in P3P3. Journal of Symbolic Computation 42 (1–2), 192–202] should be χ=−9μ−3b+5νχ=−9μ−3b+5ν. This mistake does not affect the rest of the paper. We also take the opportunity to supply details of the proof that were only hinted at there.Journal of Symbolic Computation 04/2009; 44(4):417–418. · 0.39 Impact Factor
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ABSTRACT: BACKGROUND: Caesarean section is a commonly performed childbirth procedure. While caesarean section is undeniably a lifesaving procedure for some mothers and babies, it can also be an unnecessary procedure for others. Different factors may be involved in the rate of birth by caesarean section. QUESTION: This qualitative study was conducted in Kashan city, Iran, to explore obstetrician's views of what might influence pregnant women's choice of delivery method. METHODS: Obstetricians' views and experiences were collected using semi-structured interviews. Interviews were conducted in a clinic or hospital, based on the preference of the 18 physicians who agreed to participate in the study. All interviews were recorded and transcribed. Participants were asked key questions, including: "Why do some women prefer caesarean section?"; "What kind of delivery did you have and why?"; "What kind of delivery would you recommend to pregnant women and why?" Inductive qualitative content analysis was undertaken using the method described by Morreti with 120 initial codes categorized into six categories. FINDINGS: The six categories developed from the initial codes were: factors relating to women, obstetricians, delivery conditions, complications, society's beliefs and the health system. CONCLUSION: A qualitative study conducted in Iran showed that most of the factors identified by participants facilitated the choice of caesarean section. Vaginal birth was anticipated as a painful and lengthy process, with low cultural acceptance and resulting in less income for obstetricians.Women and Birth 10/2012;
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ABSTRACT: Background: Pregnant women with a previous Caesarean section face making the decision to undergo an elective repeat Caesarean section or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). One of the key factors in counselling these women is the probability of a successful VBAC. We aimed to validate a prediction model for VBAC success. Methods: We performed an analysis of women at term with one prior low-transverse Caesarean section and a live cephalic singleton pregnancy who attempted a trial of labour after Caesarean (TOLAC) at 32 hospitals in Quebec between 2008 and 2012. The individual TOLAC probabilities of success were calculated without regard to ethnicity, using a prediction model previously developed in the United States. The predictive ability of the model was assessed using receiver operating characteristic curves and the area under the curve (AUC). In addition, a calibration curve was generated by plotting the predicted and observed VBAC rates. Results: Of 3113 eligible women who underwent TOLAC, we found an overall rate of VBAC of 75.3%. Beyond a predicted probability of 40%, both observed and predicted TOLAC success rates were similar. The accuracy of the model was high (AUC = 0.72; 95% CI 0.70 to 0.74, P < 0.001) as was the correlation between observed and predicted probabilities of TOLAC success (R² = 0.98). Finally, for women requiring induction of labour, observed and predicted probabilities were similar for a predicted probability ≥ 70%. Conclusion: It is possible to estimate VBAC success accurately in Quebec using a validated prediction model from the United States. This model may be used in practice without regard to ethnicity as a primary method to refine counselling during antepartum visits for women with a prior Caesarean section.Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 02/2013; 35(2):119-24.