Vaginal Birth After Cesarean Research Articles

Trend, prevalence and predictors of successful vaginal birth after caesarean section in Ethiopia: a systematic review and meta-analysis.

Vaginal birth after caesarean section (VBAC) is an alternative to a caesarean section (CS) in the absence of repeat or new indications for primary CS. There is a knowledge gap regarding the trend and successful VBAC in Ethiopia. Therefore this systematic review and meta-analysis aimed to assess the trend, pooled prevalence of successful VBAC and its predictors in Ethiopia. Electronic databases (SCOPUS, CINAHL, Embase, PubMed and Web of Science), Google Scholar and lists of references were used to search works of literature in Ethiopia. Stata version 14 was used for analysis and the odds ratios of the outcome variable were determined using the random effects model. Heterogeneity among the studies was assessed by computing values for I2 and p-values. Also, sensitivity analyses and funnel plots were done to assess the stability of pooled values to outliers and publication bias, respectively. A total of 12 studies with a sample size of 2080 were included in this study. The overall success rate of VBAC was 52% (95% confidence interval 42 to 65). Cervical dilatation ≥4cm at admission, having a prior successful vaginal delivery and VBAC were the predictors of successful VBAC. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios and the funnel plots did not show publication bias. The pooled prevalence of successful VBAC was relatively low compared with existing evidence. However, the rate was increasing over the last 3decades, which implies it needs more strengthening and focus to decrease maternal morbidity and mortality by CS complications. Promoting VBAC by emphasizing factors favourable for its success during counselling mothers who previously delivered by CS to enhance the prevalence of VBAC.

Factors that Influence Women's Decision on the Mode of Birth After a Previous Caesarean Section: A Meta-ethnography.

Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women's decision-making to support informed choices for the mode of next birth after caesarean section (NBAC). A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare's seven-step meta-ethnography approach synthesised themes. Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control. This meta-ethnography highlights health professionals' influence on women's decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

Gravida 7 para 4 abortus 2 (G7P4A2) for multiple repeat caesarean section: general or neuroaxial anesthesia

A caesarean section (CS) is a surgical procedure that has several risks, such as uterine rupture, infection, bleeding, thrombosis, and damage to the bladder, ureters, or intestines. Compared to primary CS, multiple repeat caesarean sections (MRCS) are associated with additional risks, including placenta previa, abnormal placental invasion, difficulty in surgical dissection, longer surgeries, and greater amounts of bleeding. A woman, age 40 years, G7P4A2, gravida aterm, weight 64.4 kg, height 150 cm, Mallampati score 1, open mouth >3 cm, thyromental distance > 3 fingers, neck circumference 33 cm, former caesarean section 4 times, would have her caesarean section and sterilization at Melinda Woman Hospital Bandung-Indonesia. A caesarean section was performed under general anesthesia, induction with propofol, atracurium, and sevoflurane, and maintenance anesthesia with N2O/O2-sevoflurane. Induction-delivery time: 16 minutes, uterine incision 50 seconds, baby born with 1-minute Apgar score was 9 and 5-minute Apgar score was 10. Analgetic fentanyl is given after birth at a dose of 1.5 mcg/kgBw intravenously. There were no caesarean-section complications. Postoperatively, the patient was treated in the wards. Due to concerns about heavy bleeding, which would require massive transfusions, anesthesia was performed under general anesthesia due to the fact that massive transfusions make patient uncomfortable because of various complications of massive transfusion

Second stage duration and delivery outcomes among women laboring after cesarean with no prior vaginal delivery.

We aimed to evaluate the association of the duration of the second stage with labor after cesarean (LAC) success and other outcomes among women with one prior cesarean delivery (CD) and no prior vaginal births. All women undergoing LAC that reached the second stage of labor from March 2011 to March 2020 were included in this retrospective cohort study. The primary outcome was the mode of delivery by second stage duration. The secondary outcomes included adverse maternal and neonatal outcomes. We allocated the study cohort into five groups of second stage duration. Further analysis compared <3 to ≥3 h of second stage based on prior studies. LAC success rates were compared. Composite maternal outcome was defined as the presence of uterine rupture/dehiscence, postpartum hemorrhage, or intrapartum/postpartum fever. One thousand three hundred ninety seven deliveries were included. Vaginal birth after cesarean (VBAC) rates decreased as the second stage length time interval increased: 96.4% at <1 h, 94.9% at 1 to <2 h, 94.6% at 2 to <3 h, 92.1% at 3 to <4 h and 79.5% at ≥4 h (p < 0.001). Operative vaginal and CDs were significantly more likely as second stage duration time interval increased (p < 0.001). The composite maternal outcome was comparable among groups (p = 0.226). When comparing the outcomes of deliveries at <3 h versus ≥3 h, the composite maternal outcome and neonatal seizure rates were lower in the <3 h group (p = 0.041 and p = 0.047, respectively). Vaginal birth after cesarean rates decreased as second stage time interval length increased. Even with prolonged second stage, VBAC rates remained relatively high. Increased risk of composite adverse maternal outcomes and neonatal seizures were observed when the second stage lasted 3 h or more.

High Order Cesarean Section: Is It Associated With More Operative Complications Then Lower Order Cesarean Section

Objective: To detect complications associated with higher order versus lower order cesarean section.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Mardan Pakistan, from Mar to Aug 2021.&#x0D; Methodology: The study was conducted on 210 women, the participants were categorised into two Groups: Group-I (Higherorder), who had undergone fourth and fifth cesarean sections, and Group-II (Lower order), who had undergone second and third Cesarean Sections. The presence of complications were noted in both the Groups.&#x0D; Results: The frequency of higher and lower-order Cesarean Sections was 75(35.7%) and 135(64.3%), respectively. Mean gestational age and parity were 38.96±0.69 weeks and 3.49±2.12, respectively. Dense omental adhesion was a significantly common complication in both Groups. Scar dehiscence was 35(25.9%) among Group-II. There was no significant association between the high-order cesarean section and its complications.&#x0D; Conclusion: The higher-order repeat cesarean section was not associated with more intraoperative complications when compared with lower-order cesarean section in our study. Certain factors like maternal age, parity and gestational age affect the intraoperative complications of the cesarean section.

Ventrofixed Uterus: Unfreezing the Uterus in 6 Standardized Steps.

This article presents a 6-step laparoscopic technique for dissecting a central uterine band in a ventrofixed uterus, in order to minimize injury to adjacent structures during such procedures as repeat cesarean sections and hysterectomy. The description of this laparoscopic surgical technique shows how the anatomically consistent avascular space beneath the uterine band was accessed via lateral dissection. An online video demonstrating the anatomy, anatomical free space, and secure dissection techniques is included. The proposed technique enables safe dissection of the uterine band and reduces the risk of bladder injury during uterine-preserving procedures. Accessing the anatomical free space via lateral dissection results in a safer operative field, decreased blood loss, and preserved myometrium during uterine-preserving procedures. The anatomically consistent avascular space beneath the uterine band is accessible via lateral dissection, enabling secure dissection of the uterine band. This technique can be used in both laparoscopic and open procedures, such as repeat cesarean sections. Familiarity with the anatomy of the central uterine-adhesion band can ensure a safe operation and reduce the risk of bladder injury. (J GYNECOL SURG 39:220).

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

BackgroundPart of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth. MethodsForty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model. FindingsDecision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman’s own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family. DiscussionPrevious experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women’s individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes. ConclusionDiscussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

Increased bladder injury rate during emergency and repeat cesarean section

Bladder injury is one of the complications of cesarean section (CS). It is reported that the overall incidence of bladder injury is 0.22-0.44% of CS. It is, however, unclear what factors influence this rate. The aim of this study was to determine if there is a difference in bladder injury rate between scheduled and emergency CS, as well as in primary and repeat CS at a large metropolitan hospital that serves a population at high risk for obstetric complications. In addition, the use of urology consultation following bladder injury and whether demographic factors and labor characteristics affect the rate of bladder injury were investigated. A total of 8,488 records were reviewed (4,292 primary CS and 4,196 repeat CS) from January 1, 2013 to December 31, 2020. The incidence of bladder injury was calculated and the rate of intraoperative urology/urogynecology consultation was recorded. Then the association between bladder injury and intraoperative urology/urogynecology consultation and between bladder injury and maternal age, body mass index (BMI), and gestational age were compared. There was a significant increase in risk of bladder injury in repeat CS versus primary CS (p=0.01). There was also a significant increase in risk of bladder injury in emergency CS versus scheduled CS (p=0.04). Intraoperative urogynecology/urology consultations were significantly higher in the bladder injury versus no bladder injury groups (p<0.0001). Both emergency CS and repeat CS are predictors of bladder injury with odd ratios of 5.7 and 7.4, respectively. These results add to the existing evidence that bladder injury is a rare complication in CS that may occur more often in women undergoing repeat or emergency CS than primary or scheduled CS. Given that the risk increases with repeat or emergency CS, patients should be made aware of such risks and surgeons should make careful intraoperative considerations with close postoperative follow-ups.

Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean

BackgroundThe aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix.MethodsThis 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL.ResultsA total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC.ConclusionsThe influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.

Prenatal Diagnosis of Costello Syndrome Using Noninvasive Prenatal Single Gene Testing With Maternal Blood

Introduction Costello syndrome (CS) is a rare disorder that affects multiple organ systems, which is usually diagnosed postnatally, except for 2 cases diagnosed prenatally from chromosome analysis by amniocentesis. We present the first case of prenatally diagnosed CS via maternal blood testing. Case Description A 38-year-old woman was referred for genetic screening at 28 weeks of gestational age (GA) due to polyhydramnios and shortened limbs seen on prenatal ultrasound. Cell-free DNA, noninvasive prenatal single gene screening was positive for G12S HRAS mutation, which is indicative of CS. The infant was delivered via elective repeat cesarean section at 36 weeks and 6 days GA, was admitted to the neonatal intensive care unit for respiratory distress. Physical examination was significant for macrocephaly, wide depressed nasal bridge, short neck, rhizomelic limb shortening, micropenis, and bilateral equinovarus deformity of the feet. Echocardiography on the first day showed severe pulmonary hypertension. Brain MRI showed a possible cavernous mass lesion and small arachnoid cyst over the left cerebellar hemisphere. Postnatal gene-targeted testing confirmed CS diagnosis with pathogenic variants. The infant was managed for respiratory distress, hypoglycemia, jaundice, and feet deformities. He was subsequently transferred to another hospital at 45 weeks of age for gastrostomy tube placement due to persistent difficulty with oral feeding. Discussion CS affects multiple organ systems. Clinical presentations includes short stature; macrocephaly; coarse facial features, loose and soft skin; hypotonia and joint laxity; cardiac involvement with congenital heart defect, feeding difficulty, and developmental delay. The phenotypic spectrum is wide and can range from mild features to early lethal complications mostly as a result of severe progressive Hypertrophic Cardiomyopathy (HCM) and respiratory compromise. CS is an autosomal dominant genetic disorder caused by mutations in the HRAS gene, but almost all cases have new mutations with no family history. Disease course depends on cardiac and predisposition to benign and malignant tumor complications. Treatment requires a multidisciplinary team directed toward the specific clinical findings. Conclusion To our knowledge, this is the first reported case of prenatally diagnosed CS via maternal blood testing. Molecular diagnosis in the prenatal period allows neonatal care providers to prepare for potential complications in the postnatal period.

Evaluation of Complication of Repeat Cesarean Section: A Study of 100 Patients in a Tertiary Care Hospital in Bangladesh

Background: Worldwide, caesarean section (CS) is one of the most commonly performed obstetric procedures. Maternal mortality and morbidities associated with repeat caesarean section is an important health problem in global perspective that needs to be addressed. Objectives: To evaluate the complications of repeat caesarean section. Materials and Method: This cross-sectional descriptive study was conducted in the department of Obstetrics &amp; Gynaecology, Rangpur medical college hospital, Rangpur from July ’18 to June ‘20 after acceptance and ethical clearance of the protocol. During data collection total admitted patient were 2123 out of which 446 caesarean section was done among them 100 patients of my study population were selected by fulfilling inclusion and exclusion criteria. After full explanation, informing the details of the purpose of the study informed written consent was obtained from the study subjects/ or her legal gardian. After Meticulous history taking thorough physical examination was done on every patient and available investigations according to the need of management was done in the hospital. Per operative and postoperative complications were noted. Information’s were collected in predesigned questionnaire and presented in tabulated form and that was finally was analyzed with the help of computer program SPSS (Statistical Package for Social Science) version 23. Result: Total patient admitted during my data collection were 2123 and of them 446 caesarean sections were done and repeat caesarean sections were 100. The incidence of repeat caesarean section was 22.42%. 35% respondents were between &gt;25-30 years of age. Average gestational age was &gt;36 – 40 weeks. Emergency caesarean section was done in 79% cases and elective in 21% cases. 68% patients had adhesion, 38% had uterine atonicity, 26% had injury to the surrounding structure, placenta previa was found in 7% cases and morbid adhesion of placenta was found in 3% cases. Additional procedures like blood transfusion needed in 34% cases, adhesiolysis performed in 21% cases, ICU admission needed in 16% cases, caesarean hysterectomy performed in 11% cases and B-Lynch suture in 8% cases. Among the postoperative complications wound infection occurred in 20% cases, PPH in 13% cases, UTI in 9% cases, paralytic ileus in 4% cases and postpartum psychosis in 3% cases. Maternal mortality was found in only 3% cases. Conclusion: Repeat caesarean section is associated with increased number of intraoperative and postoperative complications like adhesion, placenta previa, morbid adherent placenta, PPH, wound infection thus increasing maternal morbidity. So, the best way to reduce these morbidity and mortality by reducing primary caesarean section rates by taking judicious decision and indications should be appropriate and C/S should be done by well-trained doctors and specialists in well-equipped centre.

Maternal and Neonatal Outcomes of Trial of Labor Compared With Elective Cesarean Delivery According to Predicted Likelihood of Vaginal Delivery

(Abstracted from J Matern Fetal Neonatal Med 2022;35(26):10487–10493 In 2007, the Maternal-Fetal Medicine Unit (MFMU) Network developed the vaginal birth after cesarean (VBAC) calculator to help optimize the likelihood of a successful vaginal delivery. One study found that the risk of maternal and neonatal morbidity is no greater than that of elective repeat cesarean delivery (CD)—specifically when the likelihood of successful VBAC is &gt;70%.

Delivery after a previous cesarean section reviewed.

At the start of the 20th century, cesarean section (CS) was uncommon in obstetrics. By the end of the century, CS rates had increased dramatically worldwide. Although the explanation for the increase is multifactorial, a major driver in the ongoing escalation is the increase in women who are delivered by repeat CS. This is due, in part, to the fact that there has been a sharp fall in vaginal birth after CS (VBAC) rates as fewer women are offered a trial of labor after CS (TOLAC), due principally to fears of a catastrophic intrapartum uterine rupture. This paper reviewed international VBAC policies and trends. A number of themes emerged. The risk of intrapartum rupture and its associated complications is low and may sometimes be overestimated. Individual maternity hospitals in both developed and developing countries are inadequately resourced to safely supervise a TOLAC. Efforts to mitigate the risks of TOLAC by careful patient selection and good clinical practices may be underutilized. Given the serious short-term and long-term consequences of rising CS rates for women and for maternity services generally, a review of TOLAC policies worldwide should be prioritized and consideration given to convening a Global Consensus Development Conference on Delivery after CS.

Comparison between the Effect of Rectus Muscle and peritoneum closure Versus Non closure in repeated Caesarean Section on Postoperative Pain: A Randomized Controlled Trial

Comparison between the Effect of Rectus Muscle and peritoneum closure Versus Non closure in repeated Caesarean Section on Postoperative Pain: A Randomized Controlled Trial

ASSOCIATION OF SCAR TENDERNESS WITH SCAR INTEGRITY AT REPEAT CAESAREAN SECTION IN A TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

BACKGROUND: Caesarean section is an operative process whereby the fetuses after the end of 28 th week are delivered through an incision on the abdominal and uterine wall .This excludes delivery through an abdominal incision where the fetus lying free in the abdominal cavity following uterine rupture or in secondary abdominal pregnancy .The rst operation carried out on a patient is referred to as primary caesarean section .When the operation is carried out in subsequent pregnancies , it is referred to as repeat caesarean section .Caesarean section is used in cases where vaginal delivery is not either feasible or would impose undue risk on mother or baby. AIMS&amp;OBJECTIVE: METHODS: of the study to assess the relationship of scat tenderness with scar integrity at repeat caesarean section. It is a retrospective study, conducted in the admitted patients of Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar Madhya Pradesh. The duration of the study from July 2022 to December 2022. During the study pe RESULTS: riod total 130 women were admitted with diagnosis of previous caesarean section with scar tenderness, out of these 88 (66%) had gestational age &lt;37 weeks and on repeat caesarean section scar thinning present in 75(58%) cases. The scar complicat CONCLUSION: ions are highly associated with the intensity of scar tenderness .Hence forth, it can be concluded here that scat tenderness is a vital factor responsible for scar complications

Disparities in undergoing a trial of labour and successful vaginal birth after a previous caesarean section by obesity status

Obesity does not contraindicate a trial of labour after a previous cesarean section (TOLAC), but it is unclear whether pregnant individuals with obesity experience fewer TOLACs. Our objective is to assess whether pregnant individuals with obesity were less likely to undergo a TOLAC and have a successful vaginal birth after cesarean section (VBAC) than those without obesity.

Delivery features of pregnant women with a uterine scar

Vaginal delivery after a Caesarean section remains a controversial topic: there is a lack of reliable data to help doctors and women in labour to determine the best option for delivery during subsequent pregnancy. The review analyzed and summarized the results of the studies devoted to childbirth of pregnant women with scars on the uterus, considered the advantages and disadvantages of vaginal childbirth and repeat Caesarean section, the frequency of complications in the attempt of vaginal childbirth in women with scars on the uterus has been assessed. The modern medical literature available in open sources has been studied: Russian-language scientifc electronic libraries eLibrary and CyberLeninka, Englishlanguage database of medical and biological publications PubMed. It is necessary to consider the data of anamnesis and clinical-instrumental data when choosing the best management tactics of pregnancy and delivery for women with scars on the uterus. Attempting to deliver vaginally helps to reduce maternal and neonatal morbidity, and a large number of studies on this issue should help to reduce the number of unwarranted repeat Caesarean sections. Vaginal delivery after a Caesarean section is an opportunity to avoid severe abdominal surgery and negative consequences associated with repeated Caesarean sections.

Prevention of bladder damage during repeated caesarean sections

Repeated cesarean section operations are becoming a daily practice in obstetric institutions of the 2nd and 3rd groups. With each subsequent operation, due to adhesions or infectious complications (obstetric peritonitis), the risks of injuries to organs adjacent to the uterus increase. Objective: development of a method for preventing to the bladder injury during repeated cesarean section operations. Materials and methods: Prospective cohort studies were performed in 320 patients with the scar after Caesarean Section who underwent a repeated cesarean section: 186 patients were operated in plan and 134 in urgent situation. All patients had given the hydropreparation of paravesical tissue by 0.5 % solution of novocaine 20 ml, which was injected under the vesicouterine fold from the side of the round ligaments for the prevention injury of bladder. Statistical processing was carried out using the Statistica 13 package. Results and discussion: With partial mobilization of the posterior wall, bladder injury in group 1 was in 2 patients, in group 2 in 4 patients (2 = 1.544, p = 0.215). The injury of the bladder walls in group 2 occurred in patients operated on for obstetric peritonitis and was caused by pronounced infiltration of paravisical tissue and inflammatory changes in the lower segment of the uterus. Conclusions: The developed method by hydropreparation the paravesical tissue allows minimizing the number of bladder injuries with a pronounced adhesive process in the lower segment of the uterus or tissue infiltration with purulent-inflammatory complications.

An exploration of barriers to access to trial of labor and vaginal birth after cesarean in the United States: a scoping review.

Increasing the number of vaginal birth after cesarean (VBAC) deliveries is one strategy to reduce the cesarean rate in the United States. Despite evidence of its safety, access to trial of labor after cesarean (TOLAC) and VBAC are limited by many clinical and non-clinical factors. We used a scoping review methodology to identify barriers to access of TOLAC and VBAC in the United States and extract potential leverage points from the literature. We searched PubMed, Embase, Cochrane, and CINAHL for peer-reviewed, English-language studies published after 1990, focusing on access to TOLAC and/or VBAC in the United States. Themes and potential leverage points were mapped onto the Minority Health and Health Disparities Research Framework. The search yielded 21 peer-reviewed papers. Barriers varied across levels of influence and included factors related to restrictive clinical guidelines, provider reluctance, geographic disparities, and midwifery scopes of practice. While barriers varied in levels of influence, the majority were related to systemic and interpersonal factors. Barriers to TOLAC and VBAC exist at many levels and are both clinical and non-clinical in nature. The existing body of literature can benefit from more research examining the impact of recent revisions to clinical guidelines related to VBAC as well as additional qualitative studies to more deeply understand the complexity of provider reluctance.

Determination of Pain Beliefs and Anxiety Levels of Pregnant Women Who Will Have Their First and Repeated Caesarean Section

Amaç: Bu araştırma, ilk kez sezaryen olacak gebeler ile daha önce sezaryen olmuş gebelerin endişeleri ve ağrı inançlarına etki eden etmenlerin belirlenmesi amacıyla yapılmıştır.&#x0D; Yöntem: Tanımlayıcı ve kesitsel tipteki araştırmanın örneklemini, Ocak-Mart 2021 tarihleri arasında İstanbul Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi’nde ilk kez sezaryen olacak 123 gebe ve mükerrer sezaryen olacak 121 gebe olmak üzere 244 gebe oluşturmuştur. Veriler, “Kişisel Bilgi Formu”,“Endişe Şiddeti Ölçeği” (EŞÖ) ve “Ağrı İnançları Ölçeği” (AİÖ) ile elde edilmiştir.&#x0D; Bulgular: Gebelerin sezaryen sayısı ile EŞÖ ve AİÖ-O arasında anlamlı farklılık saptanmıştır (p