Does the interval since vaginal delivery influence the chance of vaginal birth after cesarean?

Objective: To examine the association between interval since vaginal delivery and vaginal birth after cesarean (VBAC).

Methods: Women with one prior low transverse cesarean and a prior vaginal delivery undergoing a trial of labor after cesarean at term were included in this cohort study. Multivariable analyses were performed to determine whether length of time since prior vaginal delivery was independently associated with VBAC and, if so, whether its inclusion enhanced the predictive capacity of previously published models.

Results: Of the 5628 women included, 4901 (87%) achieved a VBAC. Each additional year since vaginal delivery decreased the odds of VBAC by 11% (95% CI: 10–13%). When added to an existing predictive model that included only factors available at early prenatal care, interval since vaginal delivery marginally improved the model’s predictive ability (area under the curve [AUC] 0.73 versus 0.71, p?<?0.01). When added to a model that included factors available proximate to the time of delivery, the addition of interval since vaginal delivery did not change the AUC (0.76 versus 0.75, p?=?0.08).

Conclusions: A longer interval since vaginal delivery is associated with a decreased odd of VBAC. However, the addition of this interval to VBAC prediction models does not substantively improve their predictive ability.     

Prenatal screening for Down syndrome: a dilemma for the unsupported midwife?

OBJECTIVE: To explore the personal and professional concerns of midwives in relation to their experiences with women undergoing serum screening for Down syndrome. DESIGN: Semi-structured interviews. SETTING: A consultant-led maternity unit in the south of England. PARTICIPANTS: Ten midwives based in areas which most commonly support women undergoing this test. METHODS: Interviews were recorded and transcribed and a grounded theory approach involving coding was used to identify categories which were analysed. FINDINGS: Themes identified were: education needs on introduction of the test and in relation to current research about the test; strategies for explaining the concept of 'risk'; personal and professional conflict in relation to the dilemmas raised. KEY CONCLUSIONS: Accurate information (including psychosocial aspects) should be available to midwives prior to the introduction of potentially complex investigations. Continuing education should prepare midwives to meet the challenges related to prenatal screening for Down syndrome. Some strategies which could be considered include the use of reflection sheets, prompt cards and case studies or vignettes. Interprofessional education could provide the opportunity to increase understanding of individual roles and the conflicts experienced.     

Maternal serum screening for Down syndrome: are women's perceptions changing?

Objectives  To document trends in serum screening for Down's syndrome.
Background  Trends in the uptake of serum screening for Down syndrome have not been documented in a UK population.
Design  A retrospective review of the rate of uptake in a unit that has offered serum screening for Down syndrome to all pregnant women.
Setting  A large north of England hospital that has offered universal Down syndrome screening using the 'triple test' since 1992.
Patients  A total of 47 998 women who booked for antenatal care.
Main outcome measures  Uptake of serum screening for Down syndrome.
Methods  The results of the screening programme were contemporaneously recorded on a computer database, and the study team accessed the data.
Results  There was a significant reduction in the uptake of serum screening for Down syndrome from a maximum of 82.6% in 1993 to 41.4% in 2005. There was a significant but small trend upwards in the age of women accepting screening and also a significant trend in the increase in the screen-positive rates.
Conclusions  The reduction in uptake of Down syndrome screening over the past 13 years must be taken into account when planning a screening programme. Other units should be encouraged to review their rate of uptake to determine if our data are representative of a wider trend.     

Testing for Down syndrome in the older woman: a risky business?

For over 30 years, antenatal diagnosis of Down syndrome has been offered on the basis of advanced maternal age. While this was appropriate in the 1970s, developments in antenatal screening have rendered this a most inefficient strategy that is associated with excessive costs and procedure-related pregnancy losses. In this article we argue for a review of how we test for Down syndrome in the older woman.     

Could ovarian choriocarcinoma be detected by maternal serum screening for Down syndrome?

The incidence of ovarian malignancies during gestation ranges from 1 in 8000 to 1 in 20,000 deliveries. Ovarian malignancies that produce human chorionic gonadotropin (hCG) are limited to germ cell tumors, of which dysgerminoma is the most frequent (45%) malignant type encountered in pregnant patients, the others being ovarian choriocarcinoma and mixed germ cell tumors (Boulay and Podczaski, 1998). In women of childbearing age, it is hard to distinguish between metastatic choriocarcinoma on a complete mole and primary ovarian choriocarcinoma. Treatment is based on adnexectomy followed by chemotherapy. Given the extreme rarity of these tumors, the long-term prognosis is difficult to establish. Had the diagnosis for our patient been made during pregnancy, the therapeutic approach would have been discussed in terms of gestational age. In the last trimester, we could have suggested cesarean section followed by adnexectomy, and then chemotherapy. In the second-trimester, chemotherapy could have been discussed, although the fetal toxicity of cisplatin chemotherapy is not firmly defined (Ferrandina et al., 2005). This treatment is an alternative to termination of pregnancy. We retrospectively studied maternal serum biochemistry so as to assess the possibility of a diagnosis of ovarian choriocarcinoma at the time of maternal serum screening for Down syndrome.     

Does obesity affect the vaginal hysterectomy outcomes?

Objective  

To evaluate the effects of obesity on the perioperative outcomes in women who underwent vaginal hysterectomy.     

Prostaglandin for enhancing bladder function after vaginal surgery. Does it work?

Fifty women underwent vaginal hysterectomy with or without anterior and posterior colporrhaphy. After the operations the women were allocated randomly to one of three groups. One group (17 patients) received daily vaginal suppositories of 10 mg of prostaglandin E2. The second group (15) received a daily intravesical solution of 50 micrograms of prostaglandin F2 alpha dissolved in 100 mL of normal saline. The third group (18) received a daily instillation of 100 mL of saline and served as the control group. The postvoiding residual urinary volume was checked daily through a suprapubic catheter, which was removed once the residual volume was less than 50 mL. The prostaglandin did not shorten the time required for postoperative bladder drainage. The rates of febrile morbidity and hospital stay were the same in all three groups. Since most of the women in the study voided spontaneously within three days, the "sit and wait" approach seems reasonable in such patients, and prophylactic treatment to enhance bladder function after vaginal operations does not seem justified.     

Does a 'notched' nuchal translucency indicate Down syndrome fetuses or other adverse pregnancy outcome?

The aim of the present study was to assess the sonographic contour of the increased nuchal translucency (NT) and to correlate this with pregnancy outcome. Fifty sonographic images of fetuses with increased NT [> 95th centile thickness of the normal range for crown-rump length (CRL) between 38 and 84 mm] were retrospectively assessed. In all the cases a complete pregnancy and even infancy follow-up (< 36 months) was available. The NT appearances were subdivided into two forms: a 'notched' or 'uniform' appearance. The images were correlated with karyotype results [trisomy 21 (DS) vs euploid cases] and pregnancy outcome. Complicated outcomes were classified as being either DS fetuses, miscarriage or termination of pregnancy because of structural anomaly. Thus 30/35 (86%) of the euploid fetuses had a 'uniformly' increased NT, whereas 8/13 DS cases (62%) had a 'notched' appearance (Fisher's exact test, p = 0.004). Additionally, 27/29 fetuses (93%) which had an uneventful pregnancy outcome had a 'uniform' increased NT, whereas 12/26 (57%) of the fetuses which had adverse pregnancy outcome had a 'notched' appearance of their NT (Fisher's exact test, p < 0.001). Although it was not possible to correlate the sonographic data with post-evacuation microdissection findings, it is possible that a uniformly shaped, increased NT may be more representative of a developmental delay in a normal fetus. Conversely, a 'notched' nuchal surface may represent abnormal lymphatic or cardiovascular development more commonly seen in DS fetuses.     

Does obesity influence gestational hypertension?

EPH gestosis is one from most serious complications stepping out in pregnancy. Reason of occurrence gestosis to this times did not become explained in spite of existences of many theories on theme etiopathogenesis. Stoutness weighty pregnant women in opinion many authors is factor predestinating to occurrences gestosis. Material investigative determined 2 groups: one group--43 healthy weighty pregnant women, and second group--18 pregnant women with gestosis. In each groups investigated one qualified average age of women, MAP, and body mass index (BMI). Our investigations had to answer on following questions: 1. has stoutness influence on course of pregnancy and of childbirth state of new-born child? 2. has stoutness influence on height of arterial pressure in pregnancy? The results shown one ascertained correlation between MAP and BMI in group of weighty pregnant women with EPH gestosis.     

What is the biblical attitude towards personal hygiene during vaginal bleeding?

OBJECTIVE: To analyze biblical passages associated with personal hygiene during vaginal bleeding. According to the Bible, a woman who is menstruating or who has pathological vaginal bleeding is unclean. Anybody who touches such a woman's bed or her personal things is also regarded as unclean and should therefore, wash carefully. Sexual relations are forbidden within 7 days from the beginning of menstruation and during pathological vaginal bleeding. Seven days after the cessation of vaginal bleeding, a woman is considered as clean, and therefore, sexual contacts are permitted. From a modern perspective sexual contacts during menses are associated with the development of chlamydial and gonococcal diseases, the risk of transmission of the human immunodeficiency virus infection, endometriosis and subsequent infertility.This report indicates that the roots of contemporary obstetric preventive medicine can be traced to Biblical times.