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Classics Series, Landmark Trials in Medicine

Twin vaginal delivery as safe as cesarean [Classics Series]

...e subject to bias and confounding, researchers questioned whether Cesarean delivery truly lowered risk for adverse events. Given the increasing frequency of twin pregnancies and the public health goal to decrease Cesarean delivery and Cesarean-associated morbidity and mortality in the United States, researchers designed a large randomized controlled trial to assess whether perinatal outcomes differed by planned mode of delivery. Results demonstrat...

Operative vaginal delivery associated with higher risk of anal incontinence and pelvic organ prolapse

...n. Among women included in this study, it was found that operative vaginal delivery, vaginal delivery with the aid of forceps or a vacuum, was associated with a significantly higher risk of both anal incontinence and pelvic organ prolapse compared to spontaneous vaginal delivery. Five years following operative vaginal delivery, the cumulative incidence was highest for stress urinary incontinence followed by overactive bladder. However, 10 years fo...

Unexpected delivery outcomes associated with postpartum depression

...personal sense of failure or perceived disappointment from friends and family that vaginal delivery was not achieved. Click to read the study in AJOG Relevant Reading: Screening for depression during and after pregnancy Study Author, Dr. Kathryn Houston, MD, MA, talks to 2 Minute Medicine: University of California, San Francisco, Assistant Professor, Department of Obstetrics, Gynecology & Reproductive Sciences. “Women’s preferences for mode of del...
Classics Series, Landmark Trials in Medicine

The Term Breech trial: Cesarean delivery improves perinatal outcome [Classics Series]

...ordingly, clinicians questioned whether vaginal delivery might be a similarly safe delivery mode compared to cesarean in the appropriate clinical setting. For example, in a multiparous patient in active labor with a healthy, uncompromised and appropriately sized fetus, vaginal delivery might confer an equally safe delivery for the fetus and is nearly a universally safer delivery mode for the mother compared to cesarean section. In the present work...

[Physician Comment] Long-term pelvic muscle strength reduced after vaginal childbirth, forceps delivery

...tearing occurring during pregnancy and delivery. Studies show that vaginal delivery is strongly associated with urinary incontinence and pelvic organ prolapse. Midline episiotomies and operative vaginal deliveries increase the risk of sphincter tears (in the levator ani muscle complex) and increase the risk for anal incontinence (3). However, most studies evaluating the association of childbirth with pelvic floor dysfunction have suffered from sho...

Cesarean delivery for term breech not associated with long-term benefit [Classics Series]

...ational studies demonstrated significant fetal benefit to planned cesarean delivery and subsequently a multicenter randomized controlled trial of over 2000 women, the Term Breech Trial, confirmed these findings. The landmark Term Breech Trial demonstrated a risk reduction in perinatal and neonatal death and serious neonatal morbidity during delivery and through the first 6 weeks of life. It is unclear, however, if the increased risk of adverse neo...

No difference between cesarean section and vaginal delivery of twins

...tween 32 and 39 weeks gestation were randomized to either planned cesarean delivery or vaginal delivery. The frequency of adverse neonatal events within 28 days of birth was 2.2% in the cesarean delivery group and 1.9% in the vaginal delivery group (P=0.49). The frequency of adverse maternal events within 28 days of birth was 7.3% in the cesarean delivery group and 8.5% in the vaginal delivery group (P=0.29). Adverse neonatal events included death...

Cesarean delivery for term breech not associated with long-term benefit [Classics Series]

...ational studies demonstrated significant fetal benefit to planned cesarean delivery and subsequently a multicenter randomized controlled trial of over 2000 women, the Term Breech Trial, confirmed these findings. The landmark Term Breech Trial demonstrated a risk reduction in perinatal and neonatal death and serious neonatal morbidity during delivery and through the first 6 weeks of life. It is unclear, however, if the increased risk of adverse neo...

Association of bacterial vaginosis and low birthweight infants [Classics Series]

...infant. Original Date of Publication: December 1995 Study Rundown: Preterm delivery, delivery before 37 weeks gestation and low birthweight, birthweight of <2,500 grams, infants are two of the most complicated problems in obstetrics. While the incidence of LBW infants declined from the late 1980’s to the early 1990’s, the incidence of premature low birthweight infants increased. This prompted investigation of risk factors for preterm delivery of l...

Patient Basics: Cesarean Section

...uired. This is sometimes used in an emergency situation as it may be slightly faster. After the abdomen is opened, the bladder is protected from injury, and the uterus is opened. The incision in the uterus is usually horizontal and low in the uterus. Or it may be vertical. A vertical incision is preferred when a larger uterine incision is needed, or if the lower part of the uterus has not developed or stretched enough to permit a low horizontal in...

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