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Cesarean section: analysis of the experience before and after the National Consensus Conference on Aspects of Cesarean Birth.

https://arctichealth.org/en/permalink/ahliterature221258
Source
CMAJ. 1993 Apr 15;148(8):1315-20
Publication Type
Article
Date
Apr-15-1993
Author
S R Soliman
R F Burrows
Author Affiliation
Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ont.
Source
CMAJ. 1993 Apr 15;148(8):1315-20
Date
Apr-15-1993
Language
English
Publication Type
Article
Keywords
Adult
Breech Presentation
Canada
Cesarean Section - statistics & numerical data - utilization
Consensus Development Conferences as Topic
Cross-Sectional Studies
Dystocia - surgery
Female
Humans
Labor, Induced
Logistic Models
Multivariate Analysis
Ontario
Parity
Physician's Practice Patterns - statistics & numerical data
Pregnancy
Retrospective Studies
Trial of Labor
Vaginal Birth after Cesarean - statistics & numerical data
Abstract
To examine the effect of recommendations to reduce the cesarean section rate issued by the National Consensus Conference on Aspects of Cesarean Birth in 1986 on obstetric practices and to identify current patient factors that predict cesarean section.
Descriptive retrospective cross-sectional study.
A tertiary care perinatal referral centre and a general teaching hospital with a level 2 nursery in Hamilton, Ont.
All patients who gave birth at the two hospitals in 1982 (4121 women) and 1990 (4431).
Cesarean section rates and indications and predictors of cesarean section.
Although a trial of vaginal delivery after cesarean section was offered 93% more often in 1990 than in 1982 (p = 0.0002), the rate of vaginal delivery increased only 2.6%, for a reduction of 8.7% in the total cesarean section rate and of 15% in the repeat cesarean section rate. The incidence rate and treatment of dystocia did not change. The rate of cesarean section for breech presentation remained unchanged, and fetal distress was rarely confirmed with pH measurement in scalp blood before cesarean section. The most important predictors of cesarean section in 1990 were previous cesarean section and labour induction. For the nulliparous women and the multiparous women with no previous cesarean section labour induction was the most important predictor.
The rate at which patients with previous cesarean section are offered a trial of vaginal delivery has increased significantly since 1982; however, the total and repeat cesarean section rates have not decreased proportionally. Induction of labour is currently the most important correctable predictor of cesarean section. The active management of dystocia, efforts to increase the rate of vaginal breech delivery and appropriate methods to diagnose fetal distress need to be improved; such improvements should reduce the cesarean section rate further.
Notes
Cites: Am J Public Health. 1987 Aug;77(8):955-93605474
Cites: N Engl J Med. 1988 Dec 8;319(23):1511-63185675
Cites: CMAJ. 1989 Nov 15;141(10):1049-532804827
Cites: JAMA. 1991 Jan 2;265(1):59-631984126
Cites: CMAJ. 1991 May 15;144(10):1243-9, 12522025819
Cites: N Engl J Med. 1984 Oct 4;311(14):887-926472401
Cites: Can J Public Health. 1982 Jan-Feb;73(1):47-517074518
Cites: N Engl J Med. 1980 Mar 6;302(10):559-636986017
Cites: Obstet Gynecol Surv. 1979 Aug;34(8):627-42113713
Cites: Health Rep. 1991;3(3):203-191801954
PubMed ID
8462053 View in PubMed
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Cesarean section in Ontario: practice patterns and responses to hypothetical cases.

https://arctichealth.org/en/permalink/ahliterature229364
Source
Can J Surg. 1990 Apr;33(2):128-32
Publication Type
Article
Date
Apr-1990
Author
J M Barnsley
E. Vayda
J. Lomas
M W Enkin
K D Pierre
G M Anderson
B A MacKinnon
Author Affiliation
Department of Health Administration, Faculty of Medicine, University of Toronto, Ont.
Source
Can J Surg. 1990 Apr;33(2):128-32
Date
Apr-1990
Language
English
Publication Type
Article
Keywords
Anesthesia Department, Hospital - utilization
Attitude of Health Personnel
Breech Presentation
Cesarean Section - statistics & numerical data
Female
Hospitals, Community
Hospitals, Teaching
Humans
Male
Obstetrics
Ontario
Organizational Policy
Physician's Practice Patterns
Pregnancy
Random Allocation
Trial of Labor
Abstract
A 40% random sample of Ontario's obstetricians were asked to respond to hypothetical scenarios for previous cesarean section, breech presentation and dystocia, and to describe their practice patterns. Their responses confirmed findings from other studies, which reported differences between physicians' responses to hypothetical cases and their actual practice. In this study, 18% chose a cesarean section for the hypothetical case of a patient who had previously undergone cesarean section and 2% chose a cesarean section for the hypothetical case of breech presentation. However, in practice, the obstetricians reported that they do cesarean section on 71% of their previous section patients and on 57% of their breech patients. Physicians in teaching hospitals were less likely than those in community hospitals to choose cesarean section for a woman who had previously undergone cesarean section both hypothetically and in practice. For breech presentation, no difference was found. The discrepancy between responses to the hypothetical cases and practice patterns could not be attributed to the absence of anesthesia services or to restrictive hospital policies.
PubMed ID
2268812 View in PubMed
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Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.

https://arctichealth.org/en/permalink/ahliterature177723
Source
Am J Obstet Gynecol. 2004 Oct;191(4):1263-9
Publication Type
Article
Date
Oct-2004
Author
Shi Wu Wen
I D Rusen
Mark Walker
Robert Liston
Michael S Kramer
Tom Baskett
Maureen Heaman
Shiliang Liu
Author Affiliation
Division of Health Surveillance and Epidemiology, Centre for Healthy Human Development, Health Canada, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. swwen@ohri.ca
Source
Am J Obstet Gynecol. 2004 Oct;191(4):1263-9
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Blood Transfusion - statistics & numerical data
Canada
Cesarean Section - mortality
Female
Hospitals, Community
Humans
Hysterectomy - statistics & numerical data
Maternal mortality
Morbidity
Pregnancy
Surgical Procedures, Elective
Trial of Labor
Uterine Rupture - epidemiology
Abstract
This study was undertaken to assess the safety of trial of labor after previous cesarean delivery.
Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section.
Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume ( or =500 births per year) obstetric units.
Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.
PubMed ID
15507951 View in PubMed
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Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study.

https://arctichealth.org/en/permalink/ahliterature310636
Source
Acta Obstet Gynecol Scand. 2019 09; 98(9):1195-1203
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
09-2019
Author
Victoria Ankarcrona
Daniel Altman
Anna-Karin Wikström
Bo Jacobsson
Sophia Brismar Wendel
Author Affiliation
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Source
Acta Obstet Gynecol Scand. 2019 09; 98(9):1195-1203
Date
09-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Factors
Female
Humans
Pregnancy
Pregnancy outcome
Registries
Sweden
Trial of Labor
Abstract
The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women =40 years, compared with women 25-29 years, after both spontaneous onset and induction of labor.
The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational weeks 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women =40 years and 264 262 nulliparous women 25-29 years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury and a 5-minute Apgar score
PubMed ID
30901074 View in PubMed
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Diagnosis of dystocia and management with cesarean section among primiparous women in Ottawa-Carleton.

https://arctichealth.org/en/permalink/ahliterature229545
Source
CMAJ. 1990 Mar 1;142(5):459-63
Publication Type
Article
Date
Mar-1-1990
Author
P J Stewart
C. Dulberg
A C Arnill
T. Elmslie
P F Hall
Author Affiliation
Department of Epidemiology and Community Medicine, University of Ottawa, Ont.
Source
CMAJ. 1990 Mar 1;142(5):459-63
Date
Mar-1-1990
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - utilization
Dystocia - diagnosis - surgery
Female
Humans
Infant, Newborn
Labor, Induced
Ontario
Parity
Physician's Practice Patterns - statistics & numerical data
Pregnancy
Trial of Labor
Abstract
We carried out a chart review study to determine the rate of diagnosis of dystocia (abnormal progress) and the use of cesarean section to treat dystocia among 3887 primiparous women who gave birth to a single baby in the vertex presentation at four hospitals in Ottawa-Carleton in 1984. Of the 3740 women who had some labour 1127 (30.1%) were given a diagnosis of dystocia. Cesarean section for dystocia was done during all phases of labour (41% of procedures in the latent phase, 38% in the active phase and 21% in the second stage). The cesarean section rate varied among the hospitals from 11.8% to 19.6%. A total of 75% of the cesarean sections were for dystocia, disproportion or failed induction. The findings suggest that cesarean section is being done for disproportion without a trial of labour beyond the latent phase and for dystocia in the absence of fetal distress. If these practices were modified the cesarean section rate could be reduced from 16% to about 8%, the rate found in some other centres and that observed in Canada in the early 1970s.
Notes
Cites: Lancet. 1987 Mar 7;1(8532):548-512881091
Cites: N Engl J Med. 1988 Dec 8;319(23):1511-63185675
Cites: Obstet Gynecol. 1984 Apr;63(4):485-906700893
Cites: Can Med Assoc J. 1981 Oct 1;125(7):723-67326654
Cites: Obstet Gynecol. 1983 Jan;61(1):1-56823339
Cites: N Engl J Med. 1980 Mar 6;302(10):559-636986017
Comment In: CMAJ. 1990 Jun 1;142(11):1187-82188718
PubMed ID
2302643 View in PubMed
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Effect of prior vaginal delivery or prior vaginal birth after cesarean delivery on obstetric outcomes in women undergoing trial of labor.

https://arctichealth.org/en/permalink/ahliterature178971
Source
Obstet Gynecol. 2004 Aug;104(2):273-7
Publication Type
Article
Date
Aug-2004
Author
Israel Hendler
Emmanuel Bujold
Author Affiliation
Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.
Source
Obstet Gynecol. 2004 Aug;104(2):273-7
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Female
Humans
Maternal Age
Medical Records
Obstetric Labor Complications - epidemiology - etiology
Pregnancy
Pregnancy outcome
Quebec - epidemiology
Retrospective Studies
Trial of Labor
Uterine Rupture - epidemiology - etiology
Vaginal Birth after Cesarean
Abstract
We sought to study the effects of prior vaginal delivery or prior vaginal birth after cesarean delivery (VBAC) on the success of a trial of labor after a cesarean delivery.
An observational study of patients who underwent a trial of labor after a single low-transverse cesarean delivery. Patients with a previous cesarean delivery and no vaginal birth were compared with patients with a single vaginal delivery before or after the previous cesarean delivery. The rates of successful VBAC, uterine rupture, and scar dehiscence were analyzed. Multivariable regression was performed to adjust for confounding variables.
Of 2,204 patients, 1,685 (76.4%) had a previous cesarean delivery and no vaginal delivery, 198 (9.0%) had a vaginal delivery before the cesarean delivery, and 321 (14.6%) had a prior VBAC. The rate of successful trial of labor was 70.1%, 81.8%, and 93.1%, respectively (P
PubMed ID
15291999 View in PubMed
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Effects of onset of labor and mode of delivery on severe postpartum hemorrhage.

https://arctichealth.org/en/permalink/ahliterature95104
Source
Am J Obstet Gynecol. 2009 Sep;201(3):273.e1-9
Publication Type
Article
Date
Sep-2009
Author
Al-Zirqi Iqbal
Vangen Siri
Forsén Lisa
Stray-Pedersen Babill
Author Affiliation
Division of Obstetrics and Gynecology, Faculty of Medicine, University of Oslo, Rikshospitalet, Oslo, Norway. iqbal.al-zirqi@rikshospitalet.no
Source
Am J Obstet Gynecol. 2009 Sep;201(3):273.e1-9
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Cesarean Section - adverse effects
Cesarean Section, Repeat
Emergency medical services
Female
Humans
Labor Onset
Logistic Models
Postpartum Hemorrhage - epidemiology
Pregnancy
Trial of Labor
Abstract
OBJECTIVE: Our purpose was to study the impact of labor onset and delivery mode on the risk of severe postpartum hemorrhage. STUDY DESIGN: This was a population-based study of 307,415 mothers who were registered in the Medical Birth Registry of Norway from 1999-2004. RESULTS: Severe postpartum hemorrhage occurred in 1.1% of all mothers and in 2.1% of those mothers with previous cesarean section delivery (CS). Compared with spontaneous labor, hemorrhage risk was higher for induction (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.56-1.88) and prelabor CS (OR, 2.05; 95% CI, 1.84-2.29). The risk was 55% higher for emergency CS and half that for vaginal deliveries (OR, 0.48; 95% CI, 0.43-0.53), compared with prelabor CS. The highest risk was for emergency CS after induction in mothers with previous CS (OR, 6.57; 95% CI, 4.25-10.13), compared with spontaneous vaginal delivery in mothers with no previous CS. CONCLUSION: Induction and prelabor CS should be practiced with caution because of the increased risk of severe postpartum hemorrhage.
PubMed ID
19733277 View in PubMed
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Elective repeat cesarean sections: how many could be vaginal births?

https://arctichealth.org/en/permalink/ahliterature220514
Source
CMAJ. 1993 Aug 15;149(4):431-5
Publication Type
Article
Date
Aug-15-1993
Author
P. Norman
S. Kostovcik
A. Lanning
Author Affiliation
Department of Family and Community Medicine, University of Toronto, Ont.
Source
CMAJ. 1993 Aug 15;149(4):431-5
Date
Aug-15-1993
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Health
Cesarean Section - statistics & numerical data - utilization
Female
Hospitals, Teaching
Humans
Ontario
Physician-Patient Relations
Pregnancy
Reoperation - statistics & numerical data
Retrospective Studies
Trial of Labor
Vaginal Birth after Cesarean - psychology - statistics & numerical data
Abstract
To determine (a) the proportion of women undergoing elective repeat cesarean section without a trial of labour who were eligible for such a trial by the 1986 guidelines of the panel of the National Consensus Conference on Aspects of Cesarean Birth, (b) whether vaginal birth after cesarean section (VBAC) was discussed with these women and (c) the reasons cited for not having a trial of labour.
Chart audit.
Level 2 perinatal care centre in a general teaching hospital.
All 313 women with a history of previous cesarean section who gave birth at the centre during 1989.
Only 93 (30%) of the 313 women underwent a trial of labour. According to the 1986 guidelines 71% were eligible. A further 13% would have been eligible according to the revised 1991 guidelines. Of the 220 women who underwent elective repeat cesarean section, only 24 (11%) had a discussion of VBAC noted in their hospital charts. However, of all 117 patients whose charts indicated discussion of VBAC 93 (79%) chose to try it. Most of the women had either questionable indications or no indication noted for undergoing repeat cesarean section.
Most of the women who underwent repeat cesarean section were eligible for a trial of labour. However, few charts noted a discussion of VBAC. Further physician and patient education is necessary to promote the appropriate use of VBAC and repeat cesarean section.
Notes
Cites: J Nurse Midwifery. 1989 Jul-Aug;34(4):179-842769442
Cites: Women Health. 1989;15(2):67-852781811
Cites: Am J Perinatol. 1989 Oct;6(4):375-92789534
Cites: N Engl J Med. 1989 Nov 9;321(19):1306-112677732
Cites: Am J Public Health. 1990 Mar;80(3):313-52305912
Cites: Soc Sci Med. 1990;31(2):203-102389156
Cites: Obstet Gynecol. 1991 Mar;77(3):465-701825136
Cites: Obstet Gynecol. 1991 Apr;77(4):498-5032002969
Cites: J Am Med Assoc. 1951 Mar 24;145(12):884-814803280
Cites: Qual Health Care. 1992 Mar;1(1):56-6010136833
Cites: Br J Obstet Gynaecol. 1991 Jun;98(6):519-231873239
Cites: JAMA. 1991 May 1;265(17):2202-72013952
Cites: J Am Board Fam Pract. 1989 Jul-Sep;2(3):169-712750558
Cites: Am J Obstet Gynecol. 1979 Nov 1;135(5):555-61500774
Cites: Clin Obstet Gynecol. 1980 Jun;23(2):507-157398161
Cites: Am J Obstet Gynecol. 1982 Feb 1;142(3):358-97065029
Cites: Obstet Gynecol. 1982 Jan;59(1):6-127078850
Cites: Am J Obstet Gynecol. 1982 Nov 15;144(6):671-87137251
Cites: Am J Obstet Gynecol. 1983 Jun 1;146(3):253-56859133
Cites: Am J Obstet Gynecol. 1985 Feb 1;151(3):297-3043970097
Cites: J Fam Pract. 1985 Sep;21(3):210-64031794
Cites: Am Fam Physician. 1988 Jun;37(6):167-713289340
Cites: Am J Obstet Gynecol. 1987 Dec;157(6):1510-53425654
Cites: Obstet Gynecol. 1987 Nov;70(5):713-73658277
Cites: Int J Gynaecol Obstet. 1988 Apr;26(2):189-962898393
Cites: Fam Med. 1988 Nov-Dec;20(6):431-63243393
Cites: CMAJ. 1989 Mar 15;140(6):625-332920336
Cites: Obstet Gynecol Clin North Am. 1988 Dec;15(4):629-383067173
PubMed ID
8348425 View in PubMed
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Evaluating professional society guidelines on vaginal birth after cesarean.

https://arctichealth.org/en/permalink/ahliterature140524
Source
Semin Perinatol. 2010 Oct;34(5):314-7
Publication Type
Article
Date
Oct-2010
Author
Emmanuel Bujold
Author Affiliation
Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre de recherche du Centre Hospitalier universitaire de Québec (CRCHUQ), Université Laval, Quebec, QC, Canada. emmanuel.bujold@crchul.ulaval.ca
Source
Semin Perinatol. 2010 Oct;34(5):314-7
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Canada
Cesarean Section, Repeat - adverse effects
Female
Fetal Macrosomia
Fetal Monitoring
Humans
Labor, Induced
Oxytocin - administration & dosage
Patient satisfaction
Practice Guidelines as Topic
Pregnancy
Risk factors
Societies, Medical
Treatment Failure
Trial of Labor
Twins
Uterine Rupture
Vaginal Birth after Cesarean - adverse effects
Abstract
The objective was to compare national guidelines regarding vaginal birth after cesarean. Along with the American College of Obstetricians and Gynecologists practice bulletin, guidelines from the Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynecologists of Canada were reviewed and compared. Although the 3 organizations agree on most of the risk factors for uterine rupture and failed vaginal birth after cesarean (VBAC), there were some variances in the recommendations to women with 2 previous cesareans and those who required oxytocin augmentation. A disagreement was also present in regard to the availability and requirement of resources to allow a trial of labor after a previous cesarean. Although concerns could be raised about how the literature is synthesized, the 3 organizations recognized the potential biases in published reports and the lack of randomized trials.
PubMed ID
20869546 View in PubMed
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The impact of labor at term on measures of neonatal outcome.

https://arctichealth.org/en/permalink/ahliterature176465
Source
Am J Obstet Gynecol. 2005 Jan;192(1):219-26
Publication Type
Article
Date
Jan-2005
Author
Bryan S Richardson
Marie J Czikk
Orlando daSilva
Renato Natale
Author Affiliation
Department of Obstetrics and Gynecology, Canadian Institutes of Health Research Group in Fetal and Neonatal Health and Development, St. Joseph's Health Care, University of Western Ontario, London, Canada. brichar2@uwo.ca
Source
Am J Obstet Gynecol. 2005 Jan;192(1):219-26
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - utilization
Female
Fetal Blood
Humans
Hydrogen-Ion Concentration
Incidence
Infant, Newborn
Intensive Care Units, Neonatal - utilization
Maternal health services
Medical Records
Ontario - epidemiology
Outcome Assessment (Health Care)
Pregnancy
Pregnancy outcome
Retrospective Studies
Risk assessment
Trial of Labor
Vaginal Birth after Cesarean - adverse effects - utilization
Abstract
The purpose of this study was to determine risk assessments for a spectrum of neonatal outcomes with elective cesarean delivery versus a trial of labor for previous cesarean section and otherwise healthy patients who deliver at term.
The perinatal/neonatal database of St. Joseph's Health Care, London, Ontario, Canada, was used to obtain the umbilical cord pH and base excess values, incidence of adverse neonatal outcomes, and patient demographics for all term (> or =37 weeks of gestation), singleton, liveborn, or intrapartum demise infants with no major anomalies who were delivered between January 1992 and March 2002 (n = 33,709 infants). Patient groupings (all patient, patient with previous cesarean delivery, and low-risk patient) with no labor versus labor were studied by a comparison of mean values/incidences for those neonatal outcomes that were available from the database with the use of linear and logistic regression analysis and controlling for potentially confounding variables.
Labor was associated with a small drop in umbilical artery pH from approximately 7.27 to 7.25 and base excess from approximately -3.1 to -5.4 mmol/L, but this was generally well tolerated, with no difference in the incidence of 5-minute Apgar scores of
PubMed ID
15672028 View in PubMed
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28 records – page 1 of 3.