BMJ  2004;329:403 (14 August), doi:10.1136/bmj.329.7462.403-a

Letter

Internationally agreed strategy is needed on vaginal birth after caesarean

The first 150 words of the full text of this article appear below.

EDITOR—The review by Guise et al concurs with other studies in showing that vaginal birth after caesarean section is harmful for fetus and mother, and repeated elective caesarean is not completely protective.¹ Systematically interrogating the 160 cases of uterine rupture reported may have not only identified important predictive factors for uterine rupture but also highlighted the heterogeneity in clinical practice that clearly exists. Such differences in case selection and trial abandonment between healthcare providers probably helps to explain the unexpected 10 times greater perinatal mortality found in Scotland² but not in the mainly US population based review by Guise et al.

The development of quality evidence based guidelines^{3 4} has been hampered by the absence of prospective clinical trials and reliance on retrospective observational data. Their guidance has focused on ensuring that women are adequately counselled on the reasons and risks and benefits of accepting or declining the trial . . . [Full text of this article]

r.varma@bham.ac.uk Birmingham Women's Hospital, Birmingham B15 2TG

j.k.gupta@bham.ac.uk Birmingham Women's Hospital, Birmingham B15 2TG

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Article

Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section

Jeanne-Marie Guise, Marian S McDonagh, Patricia Osterweil, Peggy Nygren, Benjamin K S Chan, and Mark Helfand
BMJ 2004 329: 19. [Abstract] [Full Text] [PDF]