Citiraj:
Uterine Rupture: A 10-year population-based study of uterine rupture
White Papers
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A 10-year population-based study of uterine rupture
Obstet Gynecol 2001 Apr;97(4 Suppl 1):S69
Baskett TF, Kieser KE.
Dalhousie University, Halifax, Nova Scotia, Canada
Objective:
To review the incidence, associated factors, and morbidity associated with uterine rupture.
Methods:
A 10-year (1988-1997) population-based review of 114,933 deliveries in one province.
Results:
There were 39 ruptures: 16 complete and 23 dehiscence. Thirty-seven cases had undergone a previous cesarean delivery (34 lower transverse, 2 classical, 1 (low vertical). Of the 114,933 deliveries, 11,585 (10%) were to women with a previous cesarean delivery. The incidence of uterine rupture in those undergoing a trial for vaginal delivery (4,516) was complete rupture (3/1000) and dehiscence (5/1000). Induction or augmentation of labor with oxytocics was associated with 50% of complete ruptures and 25% of dehiscence. There were no maternal deaths, but 33% of patients with complete ruptures required blood transfusion. There was one neonatal death attributable to uterine rupture.
Conclusion:
Induction and augmentation of labor are confirmed as risk factors for uterine rupture. Fetal heart rate abnormality was the most reliable diagnostic aid. Serious maternal and perinatal morbidity was relatively low.
dakle, od 4516 VBAC-a, u 7/1000 su nastali problemi, od kojih 25-50% asocirani su dripom i drugim lijekovima. naravno, tu je govora isključivo o rupture maternice, no koliko sam skužila to je i uglavnom najveći 'rizik' protiv VBAC koji se čuje.
Citiraj:
Making Choices
All of life involves some risk, and this applies to giving birth and being born, wherever the birth takes place. At home there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital. Parents choosing home birth will consider and come to terms with that risk, knowing that the risk of unnecessary interventions and the possibility of damage to the mother or baby, or both, may be far greater in hospital.
Hospital birth also increases the risk of the emotional/psychological disruption of being in an unfamiliar institution. It is well documented that other mammals, when disturbed in their nests in labour or moved to unfamiliar surroundings, have longer labours with more complications. Entering hospital undermines a woman's need to feel safe, secure and in familiar surroundings. This in turn interferes with her ability to relax and ultimately give herself up to the experience of birth. This 'letting go' - the ability to respond to a deep, instinctive knowledge of how to give birth to your baby - is an important part of letting the birth process unfold a smoothly and safely as possible.
Deciding on a hospital birth, and thus handing over responsibility to the experts, may seem the easy option. The responsibility for choosing a home birth is more obviously yours and on the surface of things may seem more complex. But the truth is, wherever you choose to give birth, it is still your baby, your body and your responsibility to balance the risks and benefits of the services on offer.
In the end, statistics alone cannot provide all the answers about where a baby should be born. They may give you food for thought, help guide you through the maze of conflicting viewpoints, help to free you from some popular misconceptions and perhaps make home birth a real option for you. To arrive at a choice which is right for you it is important to go beyond statistical data and consider the things which really influence a good birth outcome for both mother and baby. These include your own level of health, being well-nourished throughout your pregnancy, the practical as well as emotional and psychological support and care available to you during pregnancy, labour and beyond, the skills of your midwife and your own intuitive sense of where your baby should be born.
Many parents will anxiously sort through the pros and cons, but once they have chosen home birth, they discover a growing excitement and confidence in the rightness of their decision. Where to give birth is not a matter of choosing between physical safety or going with your feelings. The two are inextricably linked. Knowing this can help you trust the wisdom of your instincts in choosing the right place for your baby to be born.
Pat Thomas
1998
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