Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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An audit of 197 patients with one previous caesarean section was undertaken over a 1-year period to determine the rates of vaginal delivery and main indications for repeat caesarean section. Trial of labour was attempted in 51.3% of women, of whom 65.3% had had a successful vaginal delivery. Vaginal birth after caesarean, however, was successful in only 33.5% of women. ⋯ Maternal request was the most common indication for repeat elective caesarean section. The answer to the rising caesarean rates seems to lie in reducing the primary caesarean section rates, rigorous auditing of the unit's caesarean rates and a change in the attitude of doctors, midwives and patients towards vaginal birth after caesarean. The last might prove to be the most difficult target to achieve.
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Comparative Study
The impact of induced labour on postpartum blood loss.
It is generally believed that postpartum blood loss is less in patients whose labour is induced with prostaglandins than in patients delivered without induction. However, postpartum blood loss is known to be greater with precipitate labour and labours induced with oxytocin and prostaglandins, unless an oxytocic agent is continued after delivery. A retrospective study was undertaken at the University Hospital of the West Indies to look at the outcome of induced labour during 3 months, October-December 1998. ⋯ Blood loss was also independently directly associated with placental weight (P=0.01) and fetal birth weight (P=0.03), as well as the length of the third stage of labour (P=0.01), but not the length of the first stage of labour. Induction of labour with oxytocic agents is associated with greater blood loss. However, increased blood loss is not due to precipitate labour alone.
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This prospective study looked at the effectiveness of 400 microg oral misoprostol in the management of women with a first trimester incomplete miscarriage with retained products of conception measuring between 15 mm and 50 mm on transvaginal ultrasound scan. Of 164 eligible women, 131 agreed to participate. Successful treatment, defined as an empty uterus on scan after 10 days with no bleeding, was achieved in 77.7% of women. ⋯ Adverse effects included nausea (10.93%), diarrhoea (2.34%), vomiting (7.8%) and hypotension (4.68%). There were no infections. We concluded that a single dose of 400 microg of oral misoprostol was an effective treatment for women presenting with an incomplete miscarriage.
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This study aimed to determine the incidence of obstetric anal sphincter tears and to determine the risk factors and outcome after primary repair. This was an audit of third- and fourth-degree tears in 1997-99, occurring in a tertiary obstetric unit with 5000 deliveries per annum. The study involved 75 women with a third-degree tear occurring between 1997 and 1999. ⋯ The incidence of obstetric sphincter injury was similar to reports in the literature. Forceps and episiotomy were significant risk factors. Obstetric sphincter injury is associated with significant morbidity as 44% of our patients were symptomatic after repair.