Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation?

Fuglenes, Dorthe; Øian, Pål; Kristiansen, Ivar Sønbø

doi:10.1016/j.ajog.2008.07.021

Cited by 103 publications

(92 citation statements)

References 112 publications

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“…The obstetrician will rarely be blamed for doing a cesarean section, while may be sued for not having done it. 8 In present study out of total 16% patients underwent VBAC, which is much higher than VBAC rates of 8.5 percent according to Hamilton BE et al 9 In present study 52.17% of patients had a successful VBAC, which is lower than that in other studies Landon and associates reported a success rate for vaginal delivery of 73.41% and Gonen et al reported a success rate of 79.66%. 4,10 Cowen and colleagues reported a successful VBAC of 81%.…”

Section: Discussioncontrasting

confidence: 53%

Fetomaternal Outcome of Pregnancy With Previous Cesarean Section

Mishra¹,

Taori²,

Misri³

2014

jemds

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OBJECTIVE:The aim of the study was to see the fetomaternal outcome of pregnancy with previous cesarean section. METHODS: This study was conducted in the department of OBGYN, BARC Hospital, Mumbai from October 2011 to September 2012, a period of one year. All the pregnant women with previous one cesarean section attending ANC clinic for confinement were included in the study group after giving consent. RESULTS: Out of total75 cases, a total of 23 patients (30.67%) were given trial of labor. Out of 23 patients given trial of labor, 12 patients (52.17%) had successful VBAC. Commonest indication for unsuccessful trial of labor undergoing repeat cesarean section was nonprogress of labor (54.55%) and failed IOL (36.67%). Out of 12 patients who had successful VBAC, 3 patients (25%) had complication like episiotomy hematoma, perineal tear and cervical tear. No patients had major complications. In present study no baby had apgar score <7 at 1min and 5 min in VBAC group and elective LSCS group. CONCLUSION: The current study concludes that women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counseling for trial of labor and proper antepartum and intrapartum monitoring of patients, are key to reducing the cesarean section rates. The antepartum, intrapartum and postpartum complications are more in repeat cesarean section cases. There is no doubt that a trial of labor is a relatively safe procedure, but it is not risk free. Therefore, patient evaluation prior to TOLAC, careful observation throughout labor in a well-equipped unit with around the clock services for emergency surgery and availability of expertise is the backbone for successful VBAC.

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Section: Discussioncontrasting

confidence: 53%

Fetomaternal Outcome of Pregnancy With Previous Cesarean Section

Mishra¹,

Taori²,

Misri³

2014

jemds

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“…I disse tilfellene kan man ikke utelukke at årsakene til keisersnittet var mer komplekse, og man kan derfor komme til å overvurdere kvinnens innflytelse (13,15). Studier fra Norge og andre europeiske land viser at en stor andel av obstetrikerne oppgir at deres praksis er påvirket av frykt for rettsforfølgelse (17,18). Dette kan vaere med på å drive keisersnittsfrekvensen oppover.…”

Section: Ikke-medisinskeunclassified

Økt forekomst av keisersnitt – årsaker og konsekvenser

Tollånes

2009

Tidsskriftet

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“…Several contributing factors from both the health provider and user sides have been identified, including fear of labour pain, misconceptions about vaginal delivery, previous traumatic births, social values, personal preferences, fear of litigation, economic reasons, and convenience for both patients and doctors. [8][9][10][11] An estimated 4-18% of all caesarean sections are performed exclusively as a result of maternal request. health costs, without evident health benefits; [13][14][15][16][17][18] however, many pregnant women do not receive clear information about these risks from their health providers.…”

Section: Introductionmentioning

confidence: 99%

Googling caesarean section: a survey on the quality of the information available on the Internet

Fioretti

Reiter

Betrán

et al. 2014

BJOG: Int J Obstet Gy

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Objective To examine the quality and completeness of information on caesarean section in web pages used by laypersons in Brazil, a country with very high rates of caesarean delivery.Design Cross-sectional study.Setting Brazil.Sample A total of 176 Internet websites.Methods The term 'caesarean delivery' and 25 synonyms were entered into the most popular search engines in Brazil. The first three pages of hits were downloaded and assessed by two independent investigators using the DISCERN instrument and a content checklist.Main outcome measures Quality and completeness of information on caesarean section.Results A total of 3900 web pages were retrieved and 176 fulfilled the selection criteria. The overall average DISCERN score was 43.6 (AE8.9 SD), of a maximum score of 75; 30% of the pages were of poor or very poor quality and 47% were of moderate quality. Most pages scored low, especially in questions related to reliability of the information. The most frequently covered topics were: indications for caesarean section (80% of websites), which did not reflect clinical practice; short-term maternal risks (80%); and potential benefits of caesarean section (56%), including maternal and doctor convenience. Less than half of the websites mentioned perinatal risks and less than one-third mentioned long-term maternal risks associated with caesarean section, such as uterine rupture (17%) or placenta praevia/accreta (12%) in future pregnancies.Conclusions The quality and completeness of web-based resources in Portuguese about caesarean section were poor to moderate. Pending improvement of these resources, obstetricians should warn pregnant women about these facts and encourage them to discuss what they have read on the Internet about caesarean section.Keywords Caesarean section, doctor-patient relationships, health literacy, Internet, patient education, prenatal education.Tweetable abstract The quality and completeness of information about caesareans is poor in 176 websites used by Brazilians.Keywords Caesarean section, doctor-patient relationships, health literacy, Internet, patient education, prenatal education. IntroductionIn 1985, the World Health Organization (WHO) stated that there were no justifications for caesarean section rates higher than 10-15% anywhere in the world, 1 and yet rates are steadily increasing worldwide.2 Brazil has been the world champion of delivery by caesarean section since the early 1990s, 3 and numbers continue to rise. In 2010 over 50% of all deliveries in Brazil were by caesarean section, representing a 20% increase in just 4 years. 4,5 In the private sector, caesarean section rates are over 80%. 6,7 Reasons for increasing caesarean section rates are under investigation. Several contributing factors from both the health provider and user sides have been identified, including fear of labour pain, misconceptions about vaginal delivery, previous traumatic births, social values, personal preferences, fear of litigation, economic reasons, and convenience for both patients and doctors. [8][9][10][...

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Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation?

Abstract: Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean.

Cited by 103 publications

References 112 publications

Fetomaternal Outcome of Pregnancy With Previous Cesarean Section

Fetomaternal Outcome of Pregnancy With Previous Cesarean Section

Økt forekomst av keisersnitt – årsaker og konsekvenser

Googling caesarean section: a survey on the quality of the information available on the Internet

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