scholarly journals Study of the causes of non-acceptance of VBAC in patients with previous one LSCS in a tertiary institution

2018 ◽  
Vol 7 (12) ◽  
pp. 4945
Author(s):  
Deepa B. Karmali ◽  
Guruprasad Pednekar ◽  
Ajit A. Nagarsenkar
Keyword(s):  
Mode Of Delivery ◽  
Labor Pain ◽  
Lower Segment ◽  
Tertiary Institution ◽  
Opting Out ◽  
Lower Segment Caesarean Section ◽  
Opt Out ◽  
High Incidence ◽  
Vaginal Birth After Caesarean

Background: Many women who are eligible candidates for a VBAC (Vaginal Birth after Caesarean) in the current pregnancy opt for a repeat LSCS (Lower Segment Caesarean Section) as a mode of delivery. We decided to evaluate the proportion of patients who opt out of a VBAC and to study the causality of this trend.Methods: All patients who presented to the Dept. of OBG in our institution and were eligible to have a VBAC were included in the study till the sample size of 100 cases was met. Consultant opinion was sought prior to deciding the mode of delivery.Results: Incidence of patients of previous one LSCS who were not willing for VBAC was 4%, out of total number of deliveries and 30.7%, out of all cases of patients with previous one LSCS. The reason for not opting for a VBAC in the current pregnancy in the majority of the eligible patients was the desire for a concurrent sterilization procedure. Others cited apprehension of a scar rupture or fear of labor pain or both as their primary reason for opting out of a VBAC.Conclusions: The high incidence of ERC (Elective Repeat Caesarean) as compared to TOLAC (Trial of Labour after Caesarean) has long-term clinical and financial implications. Counseling given to the pregnant woman with an emphasis on the advantages of VBAC in order that she opts for a VBAC with confidence and enthusiasm is the only way forward.

scholarly journals Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar

2021 ◽  
Vol 10 (9) ◽  
pp. 3434
Author(s):  
Monika Dalal ◽  
Smiti Nanda ◽  
Jagjit S. Dalal ◽  
Samiksha Kaushik ◽  
Meenakshi Chauhan ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
P Value ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Emergency Caesarean ◽  
Vaginal Birth After Caesarean

Background: Women with previous LSCS often have to make a decision about mode of delivery of their second baby. As the rate of caesarean section is continuously increasing, vaginal birth after caesarean section (VBAC) is a good strategy to decrease caesarean rate. The present study was planned to assess the fetomaternal outcome in pregnancies with previous lower segment caesarean section undergoing trial of scar and to identify the factors, which can influence the outcome of trial of scar.Methods: This was a prospective observational study on 100 patients at a tertiary care institute. Pregnant women with previous LSCS were selected randomly for the study on the basis of the inclusion and exclusion criteria. Each labor monitored closely using a partogram. Decision for repeat emergency caesarean was taken by consultant. All women included in the study were followed through delivery and till discharge.Results: Out of 100 pregnant women 49 % cases had successful VBAC, 50% had emergency caesarean and one patient had laparotomy for rupture uterus. In women, who also had a prior vaginal delivery, 72% delivered vaginally, as compared to 40% of the women who did not undergo prior vaginal delivery (p value=0.003). Women who were in spontaneous labor, 59.21% delivered vaginally, whereas women who were induced, 16.6% delivered vaginally. The rate of perinatal complication was more in the patients who required an emergency CS after a failed trial. Conclusions: Our findings may encourage obstetricians to encourage VBAC in the properly screened ANC patients and decrease the rate of recommending caesarean section.

scholarly journals The First Sale Doctrine and the Economics of Post-Sale Restraints

2016 ◽  
Author(s):  
Ariel Katz
Keyword(s):  
Intellectual Property ◽  
Vertical Integration ◽  
Common Law ◽  
User Innovation ◽  
Opting Out ◽  
Opt Out ◽  
Production And Distribution ◽  
First Sale ◽  
First Sale Doctrine

The first sale doctrine limits the exclusive rights that survive the initial authorized sale of an item protected by intellectual property (IP) rights, and therefore limits the ability of IP owners to impose post-sale restraints on the distribution or use of items embodying their IP. While the doctrine has deep common law and statutory roots, its exact rationale and scope have never been fully explored and articulated. As a result, the law remains somewhat unsettled, in particular with respect to the ability of IP owners to opt-out of the doctrine and with respect to the applicability of the doctrine to situations of parallel importation.This Article provides answers to these unsettled issues. By applying insights from the economics of post-sale restraints, the Article shows that the main benefits of post-sale restraints involve situations of imperfect vertical integration between coproducing or collaborating firms, which occur during the production and distribution phases or shortly thereafter. In such situations, opting out of the first sale doctrine should be permitted. Beyond such limited circumstances, however, the first sale doctrine promotes important social and economic goals: it promotes efficient long-term use and preservation of goods embodying IP and facilitates user-innovation. Therefore, contrary to some other views, I conclude that the economics of post-sale restraints confirm the validity and support the continued vitality of the first sale doctrine.

scholarly journals Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study

10.2196/13712 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e13712 ◽  
Author(s):  
Kara P Wiseman ◽  
Kisha I Coa ◽  
Yvonne M Prutzman
Keyword(s):  
Smoking Cessation ◽  
Logistic Regression ◽  
Text Messaging ◽  
User Characteristics ◽  
Opting Out ◽  
Quit Attempt ◽  
Cessation Intervention ◽  
Opt Out ◽  
Waking Up

Background Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness. Objective The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention. Methods Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders. Results Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date. Conclusions Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation.

scholarly journals Outcome of Primigravida with high foetal head at term or onset of labour

2018 ◽  
Vol 26 (2) ◽  
pp. 122-125
Author(s):  
Mukti Rani Saha ◽  
Nahid Yasmin ◽  
Afzalunnessa Chowdhury ◽  
Shahrin Ahmed ◽  
Kamrunnahar Sweety ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Foetal Distress ◽  
Lower Segment ◽  
College Hospital ◽  
Abdominal Ultrasonography ◽  
Cephalopelvic Disproportion ◽  
Foetal Head ◽  
Medical College ◽  
Lower Segment Caesarean Section

Objective: To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. Design: A descriptive study.Place and duration of study: The study was carried out at Mugda Medical College Hospital from March 2017 to June 2017.Materials and Methods: A total of 50 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented.Results: Out of 50 primigravidae, with high foetal head there was foetal malpresentation 17(34%), Cephalopelvic disproportion 13(26%) , Foetal distress 12(24%). Lower segment caesarian section was the management of choice in more than half of the patients with high foetal head.Conclusions: Foetal malpresentation & Cephalopelvic disproportion were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in more than half of the patients with high foetal head.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 122-125

scholarly journals Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases

2018 ◽  
Vol 7 (7) ◽  
pp. 2596
Author(s):  
Renu Jain
Keyword(s):  
Caesarean Section ◽  
Retrospective Analysis ◽  
Caesarean Delivery ◽  
Admission Rate ◽  
Active Phase ◽  
Vaginal Birth ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Increased Risk ◽  
Vaginal Birth After Caesarean

Background: Vaginal birth after Caesarean delivery (VBAC) has long been proposed as a viable measure to reduce overall Caesarean delivery rates. The objective of present study was to assess predictive factors and to study outcome of pregnancy in women with one previous lower segment caesarean section underwent trial of scar, in author’s hospital setting.Methods: This retrospective analysis of 200 pregnant women with one previous lower segment caesarean section underwent trial of scar, was carried out over a period of one year, in department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior (M.P.). The maternal and neonatal data and data concerning the course of delivery were reviewed and subjected to statistical analysis.Results: The success rate of VBAC was 36%. Young maternal age, gestational age <40 weeks, neonate birth weight 2.5-3 kg, admission in active phase of labor, previous caesarean for malpresentation, meconium stained liquor and fetal distress, were associated with successful VBAC. The commonest indication of repeat caesarean section was non-progress of labor in 34.37% women. Admission rate to neonatal intensive care unit was less in VBAC (2.77%) than in repeat caesarean section group (7.03%). There was one case of uterine rupture. There were 3 perinatal deaths and no maternal deaths.Conclusions: Women with a prior caesarean section are at increased risk of subsequent caesarean. Vaginal birth after caesarean should be encouraged in selected cases to reduce the risks of repeated caesarean sections. However, in the event of a failed trial, there is a definite increase in neonatal and maternal morbidity which is also reflected in our study.

scholarly journals Comparison of Expectant Management Versus Induction of Labour at 40 Weeks on Successful Vaginal Birth Rate in Women with a Previous Caesarean Section: A Randomized Controlled Trial and A Pilot Study.

2021 ◽  
Author(s):  
Rajalakshmi K ◽  
Gowri Dorairajan ◽  
Swetha Kumar ◽  
Palnivel Chinnakali
Keyword(s):  
Caesarean Section ◽  
Birth Rate ◽  
Controlled Trial ◽  
Expectant Management ◽  
Vaginal Birth ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Oxytocin Infusion ◽  
Low Risk Women ◽  
Vaginal Birth After Caesarean

Objective: to compare the vaginal birth rate in women with previous one lower segment caesarean section when induced at 40 weeks compared to expectant management till 41 weeks. Design: A randomized controlled trial Setting: Department of Obstetrics and Gynaecology, JIPMER, a tertiary care teaching institution in the south of India. Population or Sample: Low-risk women with previous one single lower segment caesarean section with a singleton foetus in vertex presentation and eligible for a trial of labour (TOLAC) at 40 weeks gestation. Methods: Block randomization to two groups of thirty each. The induction group was induced at 40 weeks with low dose oxytocin infusion or ripening with a single application of a single balloon Foley catheter followed by oxytocin infusion 24 hours later. The expectant group was managed in the hospital with maternal and foetal surveillance and induced at 41 weeks if they had not delivered by then. Main Outcome Measures: Vaginal birth after caesarean section (VBAC). Results: The demography and pregnancy variables were comparable in the two groups. Twenty out of thirty women (66.67%) had a successful vaginal birth after caesarean section in the induction group compared to ten out of 30 (33.33%) in the expectant group. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P=0.016) Conclusions: Among low-risk women with previous one lower segment caesarean section willing and eligible for TOLAC, the successful VBAC rate is significantly higher among those induced at 40 weeks compared to those managed expectantly till 41 weeks.

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