Success Rate Of Vaginal Birth Research Articles

Vaginal birth of twins after a previous Cesarean section.

To determine whether a vaginal birth of twins after a Cesarean section carried greater risk than for a singleton gestation as well as determining whether there was a similar likelihood of successful vaginal birth. A retrospective study was carried out of all twin pregnancies in which vaginal birth was attempted after a Cesarean section, in 1991-99. The next three consecutive singleton pregnancies in which vaginal birth was attempted after a Cesarean section were also evaluated. Comparisons were made for successful vaginal birth after Cesarean section complications (blood loss, uterine rupture or dehiscence, hysterectomy, chorioamnionitis and neonatal morbidity). Where appropriate, X2 tests of association or Student's t tests were used. Significance was set at p < 0.05. A total of 19 twin pregnancies met the study criteria. There were 57 controls. Gestational ages differed slightly (twin pregnancies, 36.3 weeks; controls, 39.3 weeks). The success rate of vaginal birth after Cesarean section was 84.2% for twin pregnancies and 75.4% for controls. The incidence of postpartum hemorrhage was 5.3% for both groups. One uterine rupture occurred in the control group; none occurred in the twin pregnancy group. One uterine dehiscence occurred in each group. No significant differences were found for any of the other parameters tested. The option of vaginal birth of twins after Cesarean section appears to have a similar risk and shares a similar likelihood of success to those of a singleton pregnancy. In view of the lack of increased complications, this option can be offered to patients with twin pregnancies who are eligible for vaginal birth after Cesarean section.

The effect of uterine rupture on fetal heart rate patterns

The high success rate of vaginal birth after cesarean section (VBAC) and its low association with complications has led to VBACs being attempted at all types of facilities, including birth centers. It must be kept in mind that unpredictable uterine rupture can occur and that uterine rupture necessitates emergency intervention. The only reported predictable feature of fetal heart rate patterns in response to uterine rupture is the sudden onset of fetal bradycardia. Fetal patterns are presented to illustrate this finding.

Nurse-midwifery service in a rural setting

This article describes the structure and development of a successful, rural nurse-midwifery service consisting of nine certified nurse-midwives and four obstetricians. The model has shown that the addition of a nurse-midwifery service and the adoption of a collaborative care model can improve obstetric outcomes. The outcomes of this model include an increase in the number of women served each year, a decrease in the cesarean section rate, an increase in the number of twin gestations delivered vaginally, an increase in the number of breech presentations delivered vaginally, an increase in the success rate of vaginal birth after cesarean section, and decreased numbers of episiotomies, with a resulting decrease in the number of third- and fourth-degree lacerations.