Background Multiple caesarean sections (C/S) have an impact on maternal morbidity and are ‘resource hungry’. Previous audit data (April 2008–October 2009) in this unit had shown that 44% of elective C/S were performed for ‘maternal request’ after the woman had one previous C/S. Consequently a birth after caesarean (BAC) clinic was set up where the care of women was standardised. This is Consultant led with a specialised midwife and patient information leaflets. Aims To increase the percentage of women opting for Vaginal (V) BAC resulting in an increased percentage of successful VBAC's without increasing the overall complication rate from VBAC. To standardise an induction of labour (IOL) protocol for VBAC's to improve the success rate further. Standards The delivery register was reviewed for 6 months prior to the BAC clinic (November 2009–April 2010): 40% of women with one previous C/S aimed for VBAC with a 64% success rate. Results 93 women have delivered via the BAC clinic between May-December 2010. 73% opted for VBAC of which 68% were successful. 10 women chose IOL and 3 had emergency C/S. One woman had an incidental finding of scar dehiscence in spontaneous labour. Seven babies went to NICU – 6 after emergency C/S and 1 after SVD; 4 of these infants were preterm. Conclusions There was a significant improvement in the percentage of women opting for VBAC. There was a more modest improvement in VBAC success rates which we hope will be sustained as more data becomes available. We will continue monitoring complication rates.
INTRODUCTION: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Improving the accuracy of blood loss estimation is vital to the clinical management of postpartum women. In this study we prospectively validated formulae previously derived to estimate blood loss, that were identified through a systematic review. METHODS: Pregnant women over 18 years of age delivering after 24 weeks gestational age were included. Participants had blood loss measured by reference standards that included gravimetric and direct measurement methods and by calculated estimation involving the use of formulae. The test characteristics of each formula (sensitivity, specificity and positive and negative predictive values) were determined against the reference standard. RESULTS: These results represent an interim analysis of our data. a total of 172 subjects were recruited, 39 of which delivered vaginally and 133 by caesarean section. after excluding cases with missing data, a total of 138 cases were analyzed. Of the four formulae identified to measure blood loss, two yielded meaningful results. A formula measuring percentage drop in hematocrit had a sensitivity of 73.1% and specificity of 31.4% for identifying PPH and another utilizing maternal height, body weight, and pre-and post-delivery hematocrit had a sensitivity of 44.0% and specificity of 77.9%. CONCLUSION: The study's interim analysis demonstrates that the use of formulae incorporating routinely determined variables such as pre- and post-delivery hematocrit, and/or body weight and height may be able to accurately and objectively identify cases of PPH and therefore have application in clinical and research settings.
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