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PubMed1998

The value of transvaginal ultrasonographic examination of the uterine cervix in predicting preterm delivery in patients with preterm premature rupture of membranes.

The objective of this study was to compare the value of ultrasonographic assessment of the uterine cervix and amniotic fluid tests in the prediction of the interval from admission to delivery in patients with preterm premature rupture of membranes. Ninety-two patients admitted to the hospital for preterm premature rupture of membranes between 24 and 32 weeks of gestation underwent both transabdominal amniocentesis and transvaginal ultrasonographic evaluation of the uterine cervix. Amniotic fluid analyses included cultures for aerobic and anaerobic bacteria, mycoplasmas and ureaplasmas, white blood cell count and glucose and interleukin-6 determinations. The ultrasonographic variables evaluated were cervical length, presence of funneling and cervical index ((funnel length + 1)/cervical length). The outcome measure was the interval from admission to delivery. The median interval from admission to delivery was 4.5 days (range 0-36). An abnormal uterine cervix was associated with a short time interval (cervical length < or = 20 mm, median 2 days, range 0-14 vs. median 6 days, range 0-36; p < or = 0.0001; presence of funneling, median 3 days, range 1-31 vs. median 8 days, range 0-36; p < or = 0.001; cervical index > 0.50, median 2 days, range 0-7 vs. median 8 days, range 1-36; p < or = 0.0001). However, interleukin-6 concentration in the amniotic fluid was the best predictor of the interval from admission to delivery when compared to the ultrasonographic indices and to all the amniotic variables considered. Moreover, when a multiple model was applied, the cervical index significantly and independently improved the performance of interleukin-6 in the prediction of the interval from admission to delivery. These data suggest that the combined use of the amniotic fluid interleukin-6 assay and the cervical index in patients with preterm premature rupture of membranes provides a good prediction of the interval from admission to delivery, thus identifying a subgroup of patients at high risk of imminent delivery.

Adult↗
PubMed2001

Quantitative analysis of synthetic gene delivery vector design properties.

As intracellular gene delivery pathways are highly complex combinations of multiple potentially rate-limiting cellular and molecular processes, approaches to the design of synthetic delivery vectors focusing on any single barrier individually will likely be suboptimal. We offer here an "integrative systems" approach to vector characterization and design, combining quantitative experiment and computational modeling studies of vector uptake and trafficking kinetics. This model is validated using data for delivery of a green fluorescent protein (GFP)-encoding plasmid by means of Lipofectamine, permitting specification of model parameter values. The model is then used to make a priori predictions on the effect of polymer length in polyplex vectors, with additional parameter values determined from previous independent experimental studies of plasmid release. Comparison with data on GFP expression via these polyplex vectors shows that the model successfully predicts an experimentally observed biphasic dependence of expression efficiency on polymer length and quantifies the contributions of competing effects yielding the optimal intermediate polymer length. Finally, we use the model to predict potential effects of incorporating nuclear localization sequences in these kinds of synthetic vectors, and find that the degree of benefit from these will depend on the values of other key system properties including the vector unpackaging rate constant. Thus, we demonstrate the usefulness of a bioengineering, integrative-systems modeling approach to improved vector design and analysis.

Biological Transport↗
PubMed2002

[Long-memory of labor pain].

BACKGROUND: The aim of the study was to investigate the stability of labour pain recall 14-21 months after delivery, and to relate it to events during labour. MATERIAL AND METHODS: One hundred and fifteen primipara completed a visual analogue scale (VAS) on the second day after delivery, and a similar VAS 14-21 months later. Women who were delivered before completing 37 gestational weeks, had a multiple pregnancy, needed epidural analgesia, or whose infant was transferred to the neonatal care unit were excluded. Data were analysed by three different methods to minimise bias. By method 1, the proportion of VAS 2 > VAS 1 was calculated. By method 2, the accuracy of recall was defined from the equation -1 < or = VAS 2--VAS 1 < or = 1. By method 3, the VAS used was regarded as an unlimited scale, but with all observations shortened to the interval, 0 to 10 cm. Pain scores were related to obstetrical data: instrument delivery, fetal weight, duration of second stage of labour, use of pethidine and use of pudendal analgesia. RESULTS: Thirteen of 20 women (65%) who had received pethidine during labour reported a higher VAS 2 than VAS 1, compared to 27 of 95 (28%) women who had not received pethidine (p = 0.003). According to method 2, 35% of the pethidine-treated women overestimated labour pain on recall, compared to 13% in the non-pethidine-treated group (p < 0.05). According to method 3, women who were not treated with pethidine showed a decrease of 0.81 cm on the recalled VAS, compared to an increase of 1.13 cm in the pethidine-treated group (p < 0.01). None of the other investigated events during labour were related to pain recall. DISCUSSION: In general, labour pain recall fades over time or tends to be stable, but to a significantly higher number of women receiving pethidine, pain seems to intensify on recall. If further investigations show that this is an effect of pethidine itself, opioids should be used with caution during labour.

Analgesia, Obstetrical↗
PubMed1994

Umbilical cord blood gas analysis at delivery: a time for quality data.

OBJECTIVES: To address the practical problems of routine umbilical cord blood sampling, to determine the ranges for pH, PCO2 and base deficit and to examine the relationships of these parameters between cord vessels. DESIGN: An observational study of umbilical cord artery and vein blood gas results. SETTING: A large district general hospital in the UK. SUBJECTS: One thousand nine hundred and forty-two cord results from 2013 consecutive pregnancies of 34 weeks or more gestation, monitored by fetal scalp electrode during labour. RESULTS: Only 1448 (74.6%) of the 1942 supposedly paired samples had validated pH and PCO2 data both from an artery and the vein; 54 (2.8%) had only one blood sample available, 90 (4.6%) had an error in the pH or PCO2 of one vessel and in 350 (18%) pairs the differences between vessels indicated that they were not sampled from artery and vein as intended. Only 60% of the cases with an arterial pH less than 7.05 had evidence of a metabolic acidosis (base deficit in the extracellular fluid 10 mmol/l or more). Of all the cases, 2.5% had a venous-arterial pH difference greater than 0.22 units. CONCLUSIONS: Both artery and vein cord samples must be taken and the results screened to ensure separate vessels have been sampled. Interpretation of the results requires the examination of PCO2 and base deficit of the extracellular fluid from each vessel as well as the pH. Confusion about the value of cord gas measurements may be due to the use of erroneous data and inadequate definitions of acidosis which do not differentiate between respiratory and metabolic components.

Carbon Dioxide↗
PubMed2001

Single chain Fv: a ligand in receptor-mediated gene delivery.

We have used an anti-human polymeric immunoglobulin receptor (pIgR) single chain Fv (scFv) to deliver reporter genes to epithelial cells in vitro. The scFv was constructed from a monoclonal antibody directed against pIgR and a cysteine residue was added at the carboxyl end to facilitate its conjugation to polylysine (polyK) via the heterobifunctional cross-linker SPDP. ScFv-cys was expressed in Drosophila S2 cells and purified to homogeneity using conventional column chromatography. ScFv-polyK, and polyK as control, were condensed with a DNA expression plasmid containing the luciferase reporter gene driven by the CMV promoter into unimolecular (with respect to DNA) complexes under high salt conditions. Target cells were MDCK cells transfected with human pIgR and repeatedly sorted for high-level receptor expression, with untransfected MDCK cells as control. Receptor-bearing MDCK cells were readily transfected by scFv-cys containing, pIgR directed complexes, and expression could be blocked by addition of excess human secretory component (SC), the extracellular portion of pIgR. In contrast, MDCK cells that did not express pIgR were not transfected. Nontargeted complexes were not effective in transfecting MDCK cells with or without pIgR. Targeted complexes also transfected human tracheal epithelial cells in primary culture, corroborating the pIgR-mediated gene delivery. These data indicate that a scFv directed against human pIgR can direct foreign genes specifically into receptor-bearing cells in vitro. We have expressed and purified a ligand that is efficient and specific in pIgR-mediated gene delivery.

Animals↗
PubMed1995

A study of breast feeding rates at a large Australian obstetric hospital.

A prospective breast feeding survey in a large obstetric hospital was carried out from 1988 to 1991. For each year, a sample of women were interviewed following delivery and data was collected which included the method of feeding, patient status (public or private patients), age, parity, (including previous breast feeding experience), marital status, country of birth and the number of babies. The mother's feeding method after delivery and on discharge from hospital were recorded. Women who were breast feeding on discharge were interviewed at 3 months. When putting the figures for the 4 years together, the breast feeding commencement rate was 88%, the breast feeding rate on discharge was 80% and the breast feeding rate at 3 months was between 51% and 57%. Factors found to be affecting the breast feeding rate at 3 months included patient status, age and parity. Problems experienced by the mothers after discharge from hospital included nipple pain, nipple trauma and mastitis. Private patients reported a significantly higher rate of mastitis than public patients.

Adult↗
PubMed2004

The effect of disinfection by-products and mutagenic activity on birth weight and gestational duration.

Epidemiologic studies of disinfection by-products have traditionally focused on total trihalomethane (TTHM) concentration as a surrogate for maternal exposure during pregnancy. We used birth certificate data on 196,000 infants to examine the effect of third-trimester exposures on various indices of fetal development. We examined the effect of town-average concentrations of TTHM and additional exposure metrics in relation to mean birth weight, mean gestational age, small for gestational age (SGA) infancy, and preterm delivery. Trihalomethane data (TTHM, chloroform, and bromodichloromethane) from 1995-1998 were available for 109 towns in Massachusetts. Data from 1997-1998 on haloacetic acid (total haloacetic acids, dichloroacetic acid, and trichloroacetic acid), 3-chloro-4-(dichloromethyl)-5- hydroxy-2(5H)-furanone (MX), and mutagenicity were available for a limited number of towns. We observed reductions in mean birth weight (12-18 g) for maternal trihalomethane exposures > the 90th percentile compared with those < the 50th percentile. Birth weight reductions were detected for chloroform exposures > 20 microg/L and TTHM exposures > 40 microg/L. Elevated trihalomethanes were associated with increases in gestational duration and a reduced risk of preterm delivery. We found evidence of an exposure-response effect of trihalomethanes on risk of SGA, with odds ratios (ORs) ranging from 1.09 to 1.23 for bromodichloromethane exposures > 5 microg/L. Elevated mutagenic activity was associated with SGA [OR = 1.25; 95% confidence interval (CI), 1.04 to 1.51] and mean birth weight (-27 g; 95% CI, -54 to -1). Although smaller in magnitude, our findings are consistent with previous studies reporting associations between trihalomethanes and SGA. These data also suggest a relationship between fetal development indices and mutagenic activity independent of exposure to trihalomethanes, haloacetic acids, and MX.

Acetates↗
PubMed1977

Stimulus generalization from feeder to response key in the acquisition of autoshaped pecking.

During autoshaping, a 6-second presentation of one stimulus and a variable time 30-second presentation of a second stimulus alternated in appearance on a pigeon key. Grain always was delivered for 3 seconds at the end of the first stimulus interval. In the first experiment, autoshaped pecking of the stimulus preceding grain delivery began much sooner when that stimulus was a black vertical line on a white background and the other stimulus was green than when the opposite stimulus arrangement was used. Because these two stimuli differed in form, hue, brightness, and similarity in hue and brightness to the illumination of the raised feeder, three subsequent experiments examined whether the differential speed of autoshaping in the two groups was due to a feature-positive, feature-negative effect, a preference for brighter over darker stimuli, a simple preference for white over green, or stimulus generalization from the brightness or hue of the illuminated, raised feeder to the stimulus on the key preceding grain delivery. The data from these experiments showed that the first autoshaped key peck was most likely to be made to the stimulus of the same hue as that illuminating the feeder, regardless of whether that stimulus was positively or negatively associated with grain delivery. At least under some conditions, therefore, stimulus-generalization mediated response transfer of pecking grain in the presence of the hue illuminating the feeder to pecking the key illuminated by a similar hue appears to account for the occurrence of autoshaped key pecking.

Journal Article↗
PubMed1998

Paternal height and weight as determinants of birth weight in a Chinese population.

To evaluate the relationship between paternal weight and height and birth weight, 355 middle class patients with uncomplicated singleton pregnancies who booked within the first trimester were recruited from a homogenous obstetric population from a teaching hospital unit. Maternal height and prepregnant maternal weight were recorded at the booking visit. Paternal height and weight were recorded when the fathers entered the labor ward or visited the postnatal ward at or shortly after the time of delivery. These data were then correlated with the birth weight of the babies. There was a significant correlation between paternal height and weight and the corresponding maternal parameters (correlation coefficients 0.21, p<0.001 and 0.21, p < 0 > 0.01). When the crude birth weight was adjusted for the gestation at delivery, and then controlled for maternal height and weight with the use of a regression model, analysis of variance tests showed that paternal height was significantly correlated to the adjusted birth weight (p<0.01), while paternal weight only showed a marginal correlation (p = 0.05). There was a significant correlation between maternal and paternal height and weight, indicating that couples tend to be of similar sizes. When controlling for maternal size, paternal height was significantly correlated to birth weight, while paternal weight showed only marginal significance. The data suggested that paternal genetic influence could be a significant determinant of in utero fetal growth and thus birth weight.

Adult↗
PubMed2005

Follicular phase serum levels of luteinizing hormone do not influence delivery rates in in vitro fertilization cycles down-regulated with a gonadotropin-releasing hormone agonist and stimulated with recombinant follicle-stimulating hormone.

OBJECTIVE: To assess the value of serum LH measurements in early and late follicular phase as predictors of ovarian response and IVF outcome in patients treated with recombinant FSH with GnRH agonist (GnRH-a) pituitary down-regulation. DESIGN: Retrospective cohort analysis. SETTING: Institutional. PATIENT(S): Women undergoing 157 consecutive IVF cycles suppressed with leuprolide acetate (LA) started in the midluteal phase and stimulated with recombinant FSH. Only women <40 years of age and with a basal cycle day 3 serum FSH </=9 IU/L were included. INTERVENTION(S): Serum LH levels were measured on cycle days 3 (D3) and 10 (D10). MAIN OUTCOME MEASURE(S): Delivery rates. Other secondary outcome measures included fertilization rate, clinical pregnancy rate, and parameters of ovarian response (peak E(2), number of metaphase II oocytes, and number of ampules of recombinant FSH). RESULTS: No significant differences were found with respect to ovarian response, fertilization rate, and outcome of pregnancy, when three threshold values of D3 and D10 serum LH (1, 1.5, and 2 mIU/mL) were analyzed. In addition, no significant differences were found between conception (n = 87) and no conception (n = 71) groups with respect to D3 or D10 LH. Receiver operator characteristic (ROC) analysis showed that neither the serum LH concentration on D3 nor on D10 was able to discriminate between conception and nonconception cycles (area under the curve [AUC](ROC)= 0.54, AUC(ROC)= 0.56), or between delivered pregnancies and first trimester pregnancy loss (AUC(ROC)= 0.53, AUC(ROC) = 0.61). CONCLUSIONS: The suppressed levels of early and late follicular serum LH in women <40 years of age with normal ovarian function desensitized with a GnRH-a and treated with recombinant FSH are not predictive of ovarian response, pregnancy, or delivery. These data do not support the use of exogenous LH supplementation in this clinical scenario.

Adult↗
PubMed1995

Results of a nurse-delivered intervention on proficiency and nodule detection with breast self-examination.

PURPOSE/OBJECTIVES: To determine group differences in breast self-examination (BSE) frequency, proficiency, and nodule detection as a result of belief and/or informational interventions. DESIGN: Prospective, randomized, experimental design using a control group and three intervention groups. Data on outcome measures were collected one year following intervention to determine intervention effect on BSE outcome measures. SAMPLE: Women without breast cancer ranging in age from 35-88 years. METHODS: Graduate research assistants conducted in-home interviews and completed intervention delivery and data collection using a standardized protocol for each experimental group. Interventions included counseling about beliefs regarding BSE and informational counseling with BSE demonstration. A second in-home interview was conducted one year after the intervention to determine its effect on BSE outcome measures. MAIN RESEARCH VARIABLES: Self-recorded frequency, observer-rated proficiency scores, and nodule detection scores. FINDINGS: The group receiving both the belief and information interventions had significantly higher frequency (t = 2.22, p < or = 0.05) and higher proficiency scores (t = 3.22, p < or = 0.01) for BSE than the control group. The control group had significantly lower rates than the belief/information group for observed proficiency of BSE (t = 7.72, p < or = 0.01) and for nodule detection (t = 8.91, p < or = 0.01). CONCLUSIONS: The intervention consisting of information, BSE demonstration, and follow-up demonstration significantly increased logged frequency, logged proficiency, observed proficiency, and nodule detection one year postintervention. The group receiving both the belief intervention and information intervention demonstrated the highest nodule detection. IMPLICATIONS FOR NURSING PRACTICE: BSE teaching should include assessment and discussion about belief toward breast cancer and BSE while providing instruction with return demonstration.

Adult↗
PubMed1994

Syphilis in pregnant patients and their offspring.

OBJECTIVES: To determine the prevalence of syphilis in antenatal women and their babies at birth. METHODS: A cross-sectional study was made of 1508 women who delivered consecutively at Pelonomi Hospital, Bloemfontein. The initial test on each mother was a rapid plasma reagin test (RPR). If reactive, it was followed by a venereal disease research laboratory test (VDRL) and a confirmative Treponema pallidum hemagglutination test (TPHA). Cord blood was tested by a RPR test. Babies with reactive tests were examined clinically, and in addition the cord blood was tested with the VDRL test as well as the enzyme linked immunosorbent assays (ELISA) for IgG and IgM. RESULTS: At delivery the data on 1476 mothers and 1399 babies were available for analysis. Sixty-five percent of the mothers had attended antenatal clinics at least once and 17% of them had tested positive for syphilis. Only 22% of these patients had been completely treated. At delivery 15% of the mothers (including women without antenatal care) tested positive for syphilis and 8% of the babies had a reactive RPR test. Clinical stigmata of congenital syphilis were evident in 15% of these babies. CONCLUSIONS: An extremely high prevalence of syphilis (15%) was documented, as well as a major deficiency in the treatment program of these patients.

Adult↗
PubMed2005

Does discussion of possible scar rupture influence preferred mode of delivery after a caesarean section?

Using retrospective and prospective analyses of antenatal records, it was found that by 2003, discussions about the options for delivery after one lower segment caesarean section (LSCS) were almost always documented in antenatal notes, compared with only rare entries in 1993; specific mention of the risks of scar rupture were made in just under 50% in 2003. There was a considerable reduction in the proportion of women whose preference was to labour in 2003 compared with 1993 and also in the number who ultimately delivered vaginally. There was, however, no evidence that those women with whom possible scar rupture had been discussed were discouraged from attempting vaginal delivery. These data suggest that, contrary to expectations, increasing patients' involvement in their management in this situation does not result in fewer caesarean sections.

Cesarean Section↗
PubMed1994

Vulvar application of lidocaine for pain relief in spontaneous vaginal delivery.

OBJECTIVE: To evaluate the effect of topical perineal lidocaine on immediate postpartum perineal pain. METHODS: Two hundred three volunteers randomly received either 2% lidocaine jelly or chlorhexidine gluconate topically to the perineum during the second stage of labor in a double-blind study. A four-point analogue pain scale was used to rate perineal pain 30 minutes after delivery. Parametric data were evaluated with the unpaired Student t test. Nonparametric data were analyzed using Mann-Whitney, Pearson chi 2, and Mantel-haenzel tests, and forward stepwise logistic regression. RESULTS: Women receiving topical lidocaine reported less overall perceived pain (48%, P < .05) and less moderate to severe pain (52%, odds ratio 1.83, P < .04) at delivery than those receiving placebo (33 and 67%, respectively). The incidence of perineal lacerations was similar in the two groups. A logistic regression found topical lidocaine and multiparity as significant correlates of diminished peripartum pain (P < .007). CONCLUSIONS: Topical application of 2% lidocaine gel was associated with decreased pain perception in the immediate postpartum interval. If confirmed by other investigators, this technique may offer improved analgesia while minimizing the injection route with local analgesia.

Administration, Topical↗
PubMed2004

Delayed postpartum preeclampsia: an experience of 151 cases.

OBJECTIVE: Preeclampsia affects 6% to 8% of pregnancies. There are few data regarding hypertensive disorders that are diagnosed in the postpartum period. Our purpose was to determine the demographics, outcomes, and treatment of this complication. STUDY DESIGN: This was a multicenter retrospective study of women who had received a diagnosis of hypertension/preeclampsia in the postpartum period. Inclusion criteria were readmission of a patient with this diagnosis (<or=6 weeks after the delivery). RESULTS: Data from 151 women were studied. Complications included 24 cases (15.9%) of eclampsia, 9 cases (5.9%) of pulmonary edema, 6 cases (3.9%) of endomyometritis, 2 cases (1.3%) of thromboembolism, and 1 case of maternal death. Seventy-eight patients required antihypertensive medications on discharge. Subanalysis performed between the eclamptic and non-eclamptic women showed no difference among groups. CONCLUSION: Delivery does not eliminate the risk for preeclampsia and its complications. Efforts should be directed at the continued monitoring, reporting, and evaluating of the symptoms of preeclampsia during the postpartum period.

Adolescent↗
PubMed2003

Dietary quality assurance processes of the DASH-Sodium controlled diet study.

A thorough quality assurance (QA) program upholds the integrity of nutrition research studies by yielding reliable data and results. Continually evaluating the implementation of a procedure against a goal and making adjustments when needed enhance the quality of a study's conduct and outcomes. Controlled diet studies require QA processes at various steps beginning with the screening of study participants, through diet preparation and delivery to data collection. Staff training and observations with monitoring activities, are important so tasks are completed according to protocol. When several clinical sites participate as partners in a controlled diet study, uniform procedures must be followed and a formal standardized QA program will assist. The Dietary Approaches to Stop Hypertension (DASH)-Sodium study employed such a program, described in this article, that included training staff, observing procedures, monitoring data for completeness and accuracy, evaluating processes, giving feedback, and documenting that tasks were done according to protocol. Furthermore, QA processes were used in the areas of participant screening, orientation, diet adherence, food procurement and preparation, and exit interviews. Other researchers may implement similar activities to ensure quality in their nutrition research programs.

Cohort Studies↗
PubMed1994

[Bacteremia induced by labor. Is prophylaxis for infective endocarditis necessary?].

PURPOSE: To characterize the occurrence of bacteremia during delivery and to verify the necessity of prophylaxis against infective endocarditis. METHODS: The authors collected hemoculture of 100 women, 15,30 and 45 minutes after delivery. The data were collected from May 1992 until May 1993. The positive hemocultures were followed by antibiogram. RESULTS: Seven hemocultures were positive: six for Staphylococcus, one for Candida sp, Penicilium sp, Clandosporum sp and Aspergillus sp that were found in association. Four patients had prematures amniorrhexis, longer than 6 hours before delivery (p < 0.05). Six patients had labor longer than 6 hours after admission (p < 0.05). The authors did not observe differences related to vaginal delivery with or without forceps or cesarean section. The samples were all sensible to cefalotin at the antibiogram. CONCLUSION: Labor and delivery is a high risk procedure for bacteremia and so for ineffective endocarditis in susceptible patients. The statistical analysis recognize as risk factors labor longer than 6 hours inside the hospital and premature amniorrhexis. We propose the use of intravenous cefalotin 1g 60 minutes before expulsion and repeated 6 and 12 hours later.

Adolescent↗
PubMed2004

Information for pregnant women about caesarean birth.

BACKGROUND: Information is routinely given to pregnant women, but information about caesarean birth may be inadequate. OBJECTIVES: To examine the effectiveness of information about caesarean birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth register, CENTRAL (26 November 2002), MEDLINE [online via PubMed 1966-] and the Web of Science citation database [1995-] (20 September 2002), and reference lists of relevant articles. SELECTION CRITERIA: Randomised controlled trials, non-randomised clinical trials and controlled before-and-after studies of information given to pregnant women about caesarean birth. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Missing and further data were sought from trial authors unsuccessfully. Analyses were based on 'intention to treat'. Relative risk and confidence intervals were calculated and reported. Consumer reviewers commented on adequacy of information reported in each study. MAIN RESULTS: Two randomised controlled trials involving 1451 women met the inclusion criteria. Both studies aimed to reduce caesarean births by encouraging women to attempt vaginal delivery. One used a program of prenatal education and support, and the other cognitive therapy to reduce fear. Results were not combined because of differences in the study populations. Non-clinical outcomes were ascertained in both studies through questionnaires, but were subject to rates of loss to follow-up exceeding 10%.A number of important outcomes cannot be reported: knowledge or understanding; decisional conflict; and women's perceptions: of their ability to discuss care with clinicians or family/friends, of whether information needs were met, and of satisfaction with decision-making. Neither study assessed women's perception of participation in decision-making about caesarean birth, but Fraser 1997, who examined the effect of study participation on decision making, found that women in the intervention group were more likely to consider that attempting vaginal birth was easier (51% compared to 28% in control group), or more difficult (10% compared to 6%). These results could be affected by the attrition rate of 11%, and are possibly subject to bias. Neither intervention used in these trials made any difference to clinical outcomes. About 70% or more women attempted vaginal delivery in both trials, yet caesarean delivery rates exceeded 40%, at least 10% higher than was hoped. There was no significant difference between control and intervention groups for any of the outcomes measured: vaginal birth, elective/scheduled caesarean, and attempted vaginal delivery. Outcome data, although similar for both groups, were not sufficient to compare maternal and neonatal morbidity or neonatal mortality. There was no difference in the psychological outcomes for the intervention and control groups reported by either of the included trials. Consumer reviewers said information for women considering a vaginal birth after caesarean (VBAC) should include: risks of VBAC and elective caesarean; warning signs in labour; philosophy and policies of hospital and staff; strategies to improve chances of success; and information about probability of success with specific care givers. REVIEWER'S CONCLUSIONS: Research has focussed on encouraging women to attempt vaginal delivery. Trials of interventions to encourage women to attempt vaginal birth showed no effect, but shortcomings in study design mean that the evidence is inconclusive. Further research on this topic is urgently needed.

Cesarean Section↗