Journal de gynécologie, obstétrique et biologie de la reproduction
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J Gynecol Obstet Biol Reprod (Paris) · Jun 2013
[Can we do a cesarean section in less than 30min in unsuitable premises in order to follow the recommendations of the ACOG?].
This study aims to assess in clinical practice the "decision-to-delivery" interval for an emergency cesarean section depending on the type of care. ⋯ The time is influenced by the transition to the operating room, the type of anesthesia and lack of information clearly stated to the team. The fetal prognosis is not limited to the "decision-to-delivery" interval but it remains essential in situations of emergency. The 15 or 30minutes interval is discussed in the literature. Obviously, the delay must be appreciated based on certain parameters (medical personnel, architecture) and each Alpha must adapt their practice to the physical working environment to meet the recommended objectives. However, the introduction of a protocol for extreme emergencies would allow for optimal responsiveness of all the teams involved and should result in a compliance period of 30minutes. Teamwork and adherence to procedures can improve these results.
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J Gynecol Obstet Biol Reprod (Paris) · Jun 2013
[Breech delivery and scarred uterus: a special obstetrical situation?].
The management of breech delivery in patients with a history of caesarean section is a special situation requiring to anticipate the delivery route if the usual prerequisites for the acceptance of vaginal breech delivery are present. Does a history of caesarean section imply a systematic refusal of vaginal delivery in case of breech presentation or an alternative to an iterative caesarean still exists? ⋯ Vaginal breech delivery in case of a scarred uterus is possible, if each obstetrical situation is correctly studied to authorize a vaginal birth trial after a careful selection of patients and a strict management of labour. Vaginal birth does not seem to increase maternal and neonatal morbidity and mortality in this situation.