Back to the books...
So before I immerse myself once more in postpartum hemorrhage (interesting how study mirrors life) and P/PROM (Prelabor/Premature Rupture of Membranes) and the freakiness of chorioamnionitis for final exams, I wanted to pop in to report an interesting week at school, replete with guest lecture from Maternal Fetal Medicine fellow from Large University Medical Center.
In other VBAC news a lovely large (bigger than the CPM 2000 study) Canadian study on the safety of home birth had the forethought to include ~100 OOH VBAC's as our sisters up north are happy to do VBAC's at home. The results? Nice: No ruptures, and only a 19% 'failure' rate resulting in a subsequent cesarean. Incidentally, the 19% rate was roughly the same c-section rate which the midwife attended hospital birth cohort reported in the study.
Can't wait till it's published.
On the "Nasty, Mean and Awful Things Which Can Happen front, our EFM lecturer (I know, I know, we all hate EFM) offered the startling perspective (Leung) that when a previously scarred uterus does rupture (0.5% or 1 in 200 chance is the most oft quoted rate), you have 18 minutes to get the baby out - assuming he has good reserves, 10 minutes if his reserves are low. Them there's some scary thoughts, eh?
I'm officially ready for this quarter to be done. Am off to the doc on Monday to have thyroid levels drawn, I suspect I may be hypothyroid. In any case I plan on ruling that out before I pounce on him for a script for some tasty antidepressant to ease me through to Spring.
Go check out M's wee girlie. She has a new hat (on it's way), which I fear may not fit her for a coupla months... Good thing it's so cold up in Canada.
Catch you all on the flip side..
In other VBAC news a lovely large (bigger than the CPM 2000 study) Canadian study on the safety of home birth had the forethought to include ~100 OOH VBAC's as our sisters up north are happy to do VBAC's at home. The results? Nice: No ruptures, and only a 19% 'failure' rate resulting in a subsequent cesarean. Incidentally, the 19% rate was roughly the same c-section rate which the midwife attended hospital birth cohort reported in the study.
Can't wait till it's published.
On the "Nasty, Mean and Awful Things Which Can Happen front, our EFM lecturer (I know, I know, we all hate EFM) offered the startling perspective (Leung) that when a previously scarred uterus does rupture (0.5% or 1 in 200 chance is the most oft quoted rate), you have 18 minutes to get the baby out - assuming he has good reserves, 10 minutes if his reserves are low. Them there's some scary thoughts, eh?
I'm officially ready for this quarter to be done. Am off to the doc on Monday to have thyroid levels drawn, I suspect I may be hypothyroid. In any case I plan on ruling that out before I pounce on him for a script for some tasty antidepressant to ease me through to Spring.
Go check out M's wee girlie. She has a new hat (on it's way), which I fear may not fit her for a coupla months... Good thing it's so cold up in Canada.
Catch you all on the flip side..
posted by Louisa at 2:49 PM
8 Comments:
Is there a difference in time between a scarred and unscarred uterine rupture? Or did they not say?
How many surgeons can get a baby out in 10-18 minutes even if they're standing right there, scalpels at the ready, woman fully prepped etc. etc.? Which of course is seldom the case unless they were going to cut her anyway...That's an honest question, though--is there really any realistic hope for a good outcome in a uterine rupture, hospital or otherwise?
EJB,
That particular study was on catastrophic rupture of previously scarred uteri. In any event I think it's fair to say that if yours was the one in 200 scarred x1 uteri, you'd have a serious problem, regardless of where it occurred. Are there degrees of severity? I'm thinking probably not. At the end of the day, you're talking about one of, if not the most (in it's pregnant state) highly vascularized organ to which the placenta is attached. The OB's are right when they say that uterine ruptures, though rare, go very bad, very quickly when they do. There's often very little warning, and as I mentioned, you do need an OR immediately if you have any hope of saving babe... It's part of the informed consent piece which women have to be well aware of, and which must play into their decision making. I believe that there is a case to be made for the larger benefits of midwifery care in in the outcome (i.e. no induction/augmentation) but aside from that, women who do make the choice to have their VBAC babies at home must have the choice to be among the 199 women who can successfully birth, or at least attempt to birth their babies vaginally wherever they choose.
In more cheerful news, another large OB center in the neighborhood has apparently tightened seriously it's induction criteria. It was asserted that they no longer do 'elective' inductions, in an attempt to arrest the insane c-section rates these places are turning out. I suspect though, that induction for "ferry hassles" of our local mamas is still an acceptable reason. sigh.
Was there differentiation between uterine rupture and uterine scar dehiscence(sp?)? I haven't seen the studies, but I've heard that most "ruptures" associated with VBAC are actually scar dehiscences and are much more benign. Would be interesting to know if she was just trying to scare you by not giving all the information (if she even had it herself).
More info. I'm not AT ALL a stats person, but I found this at Pubmed: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17963061&ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Looks like they had 19 cases of uterine rupture out of a thousand (not all scarred uteri). Of those 19 babies, 2 died and 1 had neurological "sequele"(wth?). The rest were fine and healthy.
I really think she was just trying to scare you guys.
I'm so glad to hear that this will be the topic of your dissertation. The comment EJB made and your answer were exactly what I was wondering...though I have to say I have heard of women having a "minor" rupture of sorts in regard to size of the area involved, the tear occurring in a lower segment extending to the cervix rather than across the uterus, and other women who have had separations or windows.
And I saw your ICAN posting. I think you have gone to the right group to get some "been there, done that answers" but you will find that many of us have sought legal council only to be turned away because we are (what lawyers consider) okay. They don't see PTSD or coerced surgery as something to be upset over...I don't think I'll ever get it.
If you're interested in a smaller ICAN group, let me know.
Happy researching!
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Um... I figured out what VBAC is, but what is OOH? Out of hospital?
Hi--I guess this can seem somewhat stalker-ish of me, but I stumbled across your blog (from a blog link to another to another and another and then yours....) and it fascinated me, so *sheepish blush* I've kept on reading. I'm the mother of three children, and I'm fascinated by anything mother/birth/midwifery/labor. If you'd not like me to read your blog, of course I'll respect that! Otherwise, may I?
I imagine you've heard of Valerie El Halta? Her son (and daughter-in-law) are friends of ours.
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