J. Ludlow

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Objective  To quantify the risk of morbidity from vaginal delivery (VD) that pregnant women would be prepared to accept before requesting an elective caesarean section and to compare these views with those of clinicians.

Incidence and Etiology of Pelvic Floor Dysfunction and Mode of Delivery: An Overview

Elective cesarean section at patient request is becoming common place. Women are requesting the intervention for preservation of the pelvic floor, but there is conflicting evidence to suggest that this mode of delivery has such benefits. The risks vs. benefits of both vaginal delivery and cesarean section need to be well understood before deciding on a surgical delivery. This review outlines the current available evidence of the risks and benefits associated with vaginal delivery and elective cesarean section and the incidence and mechanisms of injury that lead to pelvic floor dysfunction. As in most surgical conditions, a better understanding of causality of pelvic floor dysfunction may help treatment effectiveness.

Does occiput posterior position in the second stage of labour increase the operative delivery rate

To assess the impact of occipito‐posterior position in the second stage of labour on operative delivery.

Willingness of pregnant women and clinicians to participate in a hypothetical randomised controlled trial comparing vaginal delivery and elective caesarean section

Background:  Elective caesarean section is controversial in the absence of compelling evidence of the relative benefits and harms compared with vaginal delivery. A randomised trial of the two procedures to compare outcomes for women and babies would provide the best quality scientific evidence to confirm this debate but it is not known whether such a trial would be feasible.

Persistent Occiput Posterior: OUTcomes following digital rotation: A pilot randomised controlled trial

To determine the feasibility of a multicentre randomised controlled trial (RCT) to investigate whether digital rotation of the fetal head from occiput posterior (OP) position in the second stage of labour reduces the risk of operative delivery (defined as caesarean section (CS) or instrumental delivery).

Transverse occiput position: Using manual Rotation to aid Normal birth and improve delivery OUTcomes (TURN-OUT): A study protocol for a randomised controlled trial.

BackgroundFetal occiput transverse position in the form of deep transverse arrest has long been associated with caesarean section and instrumental vaginal delivery. Occiput transverse position incidentally found in the second stage of labour is also associated with operative delivery in high risk cohorts. There is evidence from cohort studies that prophylactic manual rotation reduces the caesarean section rate. This is a protocol for a double blind, multicentre, randomised, controlled clinical trial to define whether this intervention decreases the operative delivery (caesarean section, forceps or vacuum delivery) rate.Methods/DesignEligible participants will be ≥37 weeks pregnant, with a singleton pregnancy, and a cephalic presentation in the occiput transverse position on transabdominal ultrasound early in the second stage of labour. Based on a background risk of operative delivery of 49%, for a reduction to 35%, an alpha value of 0.05 and a beta value of 0.2, 416 participants will need to be enrolled. Participants will be randomised to either prophylactic manual rotation or a sham procedure. The primary outcome will be operative delivery. Secondary outcomes will be caesarean section, significant maternal mortality and morbidity, and significant perinatal mortality and morbidity.Analysis will be on an intention-to-treat basis. Primary and secondary outcomes will be compared using a chi-squared test. A logistic regression for the primary outcome will be undertaken to account for potential confounders. This study has been approved by the Ethics Review Committee (RPAH Zone) of the Sydney Local Health District, Sydney, Australia, (protocol number: X110410).DiscussionThis trial addresses an important clinical question concerning a commonly used procedure which has the potential to reduce operative delivery and its associated complications. Some issues discussed in the protocol include methods of assessing risk of bias due to inadequate masking of a procedural interventions, variations in intervention efficacy due to operator experience and the recruitment difficulties associated with intrapartum studies.Trial registrationThis trial was registered with the Australian New Zealand Clinical Trials Registry (identifier: ACTRN12613000005752) on 4 January 2013.

Caesarean section at full cervical dilatation

Caesarean section at full cervical dilatation has many implications for maternal and neonatal morbidity as well as subsequent pregnancy outcomes. However, increasing trends are reported internationally for second‐stage caesarean delivery.

Single‐dose methotrexate treatment for ectopic pregnancy and pregnancy of unknown location and progesterone as a predictor of success

The use of single‐dose intramuscular administration of methotrexate in the treatment of ectopic pregnancies (EP) is a well‐established practice. This study evaluates its use at a novel dose of 40 mg/m2 body surface area (BSA).

Vertical transmission of hepatitis C: Testing and health-care engagement: Vertical transmission of hepatitis C

To investigate hepatitis C virus (HCV) testing patterns and engagement with health care for women positive for HCV antibodies (anti‐HCV) in pregnancy and their children through pregnancy and the first 2 years of the childs life.

The impact of introducing medical management on conservative and surgical management for early pregnancy miscarriage

Medical management of miscarriage allows women to avoid the risks associated with surgical intervention. In 2011 the early pregnancy assessment service (EPAS) at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia introduced medical management of miscarriage with single‐dose 800 μg vaginal misoprostol.