American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jun 2001
Using active management of labor and vaginal birth after previous cesarean delivery to lower cesarean delivery rates: aA 10-year experience.
Our objective was to analyze the statistics on cesarean delivery rates and the factors that have led to a reduction in these rates. ⋯ We found that our working plan for management of labor and delivery yielded and maintained a successful decline in the cesarean delivery rates without any negative effect on neonatal or maternal mortality rates. This low rate was maintained for a 10-year period.
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There is significant controversy about the risks related to attempted vaginal birth after cesarean and the implications for informed consent of the patient. Recent data suggest that women who deliver in hospitals with high attempted vaginal birth after cesarean rates are more likely to experience successful vaginal birth after cesarean, as well as uterine ruptures. We conducted a study to evaluate maternal and neonatal morbidity and mortality after uterine rupture at a tertiary care center. ⋯ Our data confirm the relatively small risk of uterine rupture during vaginal birth after cesarean that has been demonstrated in previous studies. In an institution that has in-house obstetric, anesthesia, and surgical staff in which close monitoring of fetal and maternal well-being is available, uterine rupture does not result in major maternal morbidity and mortality or in neonatal mortality.
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Am. J. Obstet. Gynecol. · Jun 2001
Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997.
This study aims to characterize the rate of occurrence and nature of outcomes associated with obstetrical deliveries in women with malignant neoplasms among 3,168,911 women who delivered in California in 1992 through 1997. ⋯ A lower than expected occurrence rate of obstetrical delivery associated with maternal malignancy was seen when compared with previously published hospital-based reports. Malignant neoplasms associated with obstetrical delivery were most frequently first documented in the postpartum period. Maternal and neonatal morbidity were significantly increased, yet the risk of in-hospital maternal death was not significantly elevated. A significant increase in risk of neonatal death for infants of mothers with cervical cancer was found.
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Am. J. Obstet. Gynecol. · Jun 2001
Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity.
Our purpose was to determine the maternal risks associated with failed attempt at vaginal birth after cesarean compared with elective repeat cesarean delivery or successful vaginal birth after cesarean. ⋯ Patients who experience failed vaginal birth after cesarean have higher risks of uterine disruption and infectious morbidity compared with patients who have successful vaginal birth after cesarean or elective repeat cesarean delivery. Because actual numbers of morbid events are small, caution should be exercised in interpreting results and counseling patients. More accurate prediction for safe, successful vaginal birth after cesarean delivery is needed.
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Am. J. Obstet. Gynecol. · Jun 2001
Clinical TrialA retrospective study of the effect of postoperative indomethacin rectal suppositories on the need for narcotic analgesia in patients who had a cesarean delivery while they were under regional anesthesia.
This study was undertaken to assess the efficacy of rectal indomethacin as an analgesic after cesarean delivery, comparing narcotic usage in patients receiving indomethacin with patients who received only standard narcotic analgesics. ⋯ In this uncontrolled trial the use of indomethacin rectal suppositories resulted in a significant reduction in narcotic use in the postcesarean hospital recovery period as measured in morphine equivalents.