Cesarean deliveries represent almost one third of US births. Given that repeat cesarean is the most common single indication for cesarean, trial of labor after cesarean (TOLAC) with subsequent vaginal birth after cesarean (VBAC) is an important mechanism to reduce the overall cesarean rate. The 2010 National Institutes of Health Conference found that one of the biggest barriers to VBAC is the l...

Background: We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus.Methods: This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets cont...

OBJECTIVES To estimate the independent association of episiotomy with obstetric anal sphincter injuries (OASIS) using first a cross-sectional and then a matched pair analysis. DESIGN A matched cohort. SETTING Data was gathered from the Finnish Medical Birth Register from 2004-2011. POPULATION All singleton vaginal births (n = 303,758). METHODS Women resulting matched pairs (n = 63,925) ...

OBJECTIVES To compare the risk profile of women giving birth in private and public hospitals and the rate of obstetric intervention during birth compared with previous published rates from a decade ago. DESIGN Population-based descriptive study. SETTING New South Wales, Australia. PARTICIPANTS 691 738 women giving birth to a singleton baby during the period 2000 to 2008. MAIN OUTCOME ME...

BACKGROUND Although pregnancy-related laparotomy is a major intervention, literature is limited to small case-control or single center studies. We aimed to identify national incidence rates for postpartum laparotomy related to severe acute maternal morbidity (SAMM) in a high-income country and test the hypothesis that risk of postpartum laparotomy differs by mode of birth. METHODS In a popula...

BACKGROUND In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. METHODS A qualitative study using descriptive ex...

MANAGEMENT of labor after previous cesarean delivery continues to be a controversial area of obstetric practice. Neither repeat cesarean delivery nor a trial of labor are without risk. Currently, cesarean delivery is the most commonly performed operation, and repeat cesarean delivery is the most common indication. Although the prevalence of vaginal birth after cesarean delivery (VBAC) increased...

BACKGROUND Severe perineal trauma occurs in 0.5-10% of vaginal births and can result in significant morbidity including pain, dyspareunia and faecal incontinence. The aim of this study is to determine the risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma during their first birth in New South Wales (NSW) between 2000 - 2008. METHOD All ...