BJOG : an international journal of obstetrics and gynaecology
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Observational Study
The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.
To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. ⋯ Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.
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To compare the difference in risks of neonatal and maternal complications, including uterine rupture, in a second birth following a planned caesarean section versus emergency caesarean section in the first birth. ⋯ We found a moderately increased risk of postpartum haemorrhage and a small to moderately increased risk of uterine rupture and stillbirth as a long-term effect of prior planned caesarean delivery on second births.
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To explore the risk of adverse maternal and perinatal outcomes in women with antepartum bleeding of unknown origin (ABUO). ⋯ Pregnancies complicated by ABUO are at a greater risk of preterm delivery and induced labour. There was no increase seen in perinatal mortality after adjusting for preterm birth.
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To study whether pregnancy week at delivery is an independent risk factor for shoulder dystocia. ⋯ The risk of shoulder dystocia was associated with increased birthweight, diabetes, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity and period of delivery but not with post-term delivery.
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To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information. ⋯ An evidence-based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision-making on mode of birth after caesarean section.