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Cephalopelvic Disproportion and Contracted Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Trial of labour is nothing but allowing labour in a woman with a borderline pelvis with the hope of achieving a normal vaginal delivery. The trial of labour should be properly supervised. In a primigravida, a trial of labour is worth the effort as it can avert a scheduled caesarean section and give her a chance of vaginal delivery.
Predictors of Uterine Rupture and Recurrence after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
The overall risk of UR with a history of myomectomy has been estimated to be between 0.5% and 1% [1–5]. Specifically, it is 0.47% when stratified to the subgroup of women who undergo a trial of labor (TOL); however, it can be much higher (around 1.5%) in the category of women in whom it occurs before the onset of labor [2]. About one third of the URs tend to occur within 36 weeks of gestation [2]. Transabdominal myomectomy (TAM) is associated with a UR incidence of 0.67 to 1.7%, whereas this incidence is 0.49 to 0.99% after a laparoscopic myomectomy (LM) [5].
When to Recommend a Cesarean Section
Published in John C. Petrozza, Uterine Fibroids, 2020
Matthew S. Smith, Joan M. Mastrobattista
The overall uterine rupture rate after an open myomectomy is approximately 1.7% compared with 0.49% for the laparoscopic approach [20]. This is comparable to the reported risk of rupture in women with a prior low transverse cesarean undergoing a trial of labor. In contrast, Kelly and colleagues conducted a retrospective review of the literature and noted that women with a prior abdominal myomectomy, who were allowed to labor and achieved vaginal delivery, had no uterine rupture [21]. Several case series after laparoscopic myomectomy report no uterine rupture before labor; however, a prior review reports on 19 cases with most uterine ruptures occurring prior to labor and 15 prior to 36 weeks [22].
A survey on the current practice of indicating an elective cesarean after a previous myomectomy
Published in Annals of Medicine, 2023
Giovanni Delli Carpini, Valeria Verdecchia, Luca Giannella, Jacopo Di Giuseppe, Barbara Gardella, Pantaleo Greco, Ettore Cicinelli, Andrea Ciavattini
What seems to emerge from the analysis of the management of pregnant women with a previous myomectomy is that providing information to patients and among clinicians plays a crucial role. First, after a myomectomy, patients who became pregnant should receive adequate counseling regarding the risks associated with their previous surgery from a senior clinician [27]. Second, a detailed transmission of information related to myomectomy from the surgeon to the clinician who will manage the pregnancy is mandatory to collect all available data and appropriately propose the mode of delivery [5]. This is particularly important to avoid indicating a cesarean delivery for patients with a low risk of uterine rupture rather than to indicate with certainty the safety of a trial of labor after myomectomy.
Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Anna Toijonen, Pia Hinnenberg, Mika Gissler, Seppo Heinonen, Georg Macharey
On the contrary, caesarean section in planned term deliveries is associated with an increased maternal short-term morbidity (Hofmeyr et al. 2015). Having had a planned term caesarean birth compared with planned vaginal birth might also cause in subsequent pregnancies adverse outcomes. Women with at least one previous caesarean section are more likely to have another caesarean (Uddin and Simon 2013). Several studies also indicate that women with a previous caesarean section are more often in need of a blood transfusion. They have an increased risk of endometritis, uterine rupture, hysterectomy, and death (Royal College of Obstetricians and Gynaecologists 2015). Women with a history of caesarean section suffer more often from placenta previa (Jauniaux et al. 2019), and abnormally invasive placentation like placenta accrete (Silver et al. 2006). A history of planned caesarean birth at term increases the risk of stillbirth and neonatal morbidity during subsequent pregnancy (O'neill et al. 2013). For caesarean sections in preterm pregnancies, the risks named above might be even higher, as during a caesarean section, often, an enlarged uterotomy is necessary to deliver the foetus safely. These enlarged incisions are more traumatic compared to the usual lower segment incisions, as the uterus is quite often opened up to the fundus (Figure 1). However, women with a history of preterm caesarean have high rates of successful trial of labour in a subsequent term pregnancy (Rietveld et al. 2019).
Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery
Published in Journal of Legal Medicine, 2018
Thankfully, a court-ordered cesarean delivery is rare. In the overwhelming majority of obstetric cases, the pregnant woman and her physician agree regarding the use of a cesarean section.139 To date, there are only four published decisions from an appellate court on this issue.140 Only one of these four cases involves a laboring woman.141 In Pemberton, a woman with a prior classical uterine incision (a vertical incision on the uterus that extended into the thickened, contractile portion of the uterine muscle) refused a cesarean delivery against the advice of multiple physicians and, instead, attempted an unmonitored vaginal birth at home.142 The court found that the trial of labor, in the setting of this particular type of uterine incision, was associated with a 4% to 6% risk of uterine rupture,143 which, if it occurred, would result in “almost certain death.”144 The court found this risk to be “very substantial,” noting that “if an airline told prospective passengers there was a four to six percent chance of a fatal crash, nobody would board the plane.”145 The court found the woman’s refusal to undergo a cesarean to be unreasonable and inappropriate.146 Accordingly, the court ordered a cesarean delivery in order to prevent significant maternal and neonatal complications.147