Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Comparative Study
Induction of labour after a previous caesarean section: a retrospective study in a district general hospital.
A retrospective study was undertaken in a district general hospital to identify factors associated with vaginal delivery, as opposed to caesarean section, in women undergoing induction of labour after a previous caesarean section. The study was undertaken over 9 years (April 1994 - May 2003) and included patients in their second or subsequent pregnancy who had previously had one lower segment caesarean delivery and in whom labour had been induced. Records were extracted from a database and anonymised. ⋯ Two factors had a statistical significant relationship with vaginal birth after induction of labour; occipito-anterior position (OR 10.18, 95% CI 1.42 - 112.7, Yates corrected chi2; p = 0.001) and more than one previous birth (OR 4.76, 95% CI 1.28 - 21.67, p = 0.017). Other associations were explored but were not statistically significant. This paper contributes to the literature on factors associated with vaginal delivery after induction of labour and previous caesarean section, which may inform the selection of cases, and consequent success rates for vaginal delivery.
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Audit of the quality of gynaecological care is essential so that errors due to medical interventions can be reduced to the bare minimum. The aim of this study was to determine the incidence and nature of adverse gynaecological events. The clinical records of all women admitted with gynaecological conditions over 9 months were assessed for adverse events, defined as an injury caused by medical management rather than the underlying disease. ⋯ The frequency of adverse events increased with age, the presence of co-existing illnesses, and severity of the illness on admission. Therapeutic mishaps (n = 67; 8%) were the most common type of adverse event. Lessons learnt from audit should reduce adverse events considerably.