Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Arteriovenous malformations (AVMs) have a poorly defined natural history, more so in the pregnant population. Presentation during the pregnancy is usually as a result of haemorrhage following rupture. Whether pregnancy alters the natural tendency to rupture remains controversial, but empirical data suggest that this is the case. ⋯ In those patients in whom a lesion is deemed operable (low risk), surgery may improve the risks of poor outcome provided treatment risks are low. Factors such as AVM morphology, local expertise and support facilities (including those for endovascular therapy) are essential considerations if outcome is to improve on the natural history of the condition. Preoperative endovascular embolisation can be included when considering surgical excision.
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The Changing Childbirth report, 1999, explicitly endorsed the right of women to be involved in childbirth decisions and to have a choice in childbirth and it has been suggested that maternal requests for a caesarean birth has been a significant factor in the recently observed increases in caesarean section rates. There have been reports of both obstetrician's views and midwives' views regarding the mode of delivery. However, there is a lack of literature reporting the views of women who have experienced personally both a caesarean section and a vaginal delivery. Fifty women in Milton Keynes who had had at least one vaginal delivery and at least one caesarean section were asked for their opinion.