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The objective of this study was to determine how obstetricians would wish to be managed in their own pregnancy and their advice to patients delivering after a caesarean section. A questionnaire was sent to 219 consultant obstetricians in two large UK medical deaneries investigating their personal preferences for delivery and management of spontaneous, augmented and induced labour after a caesarean section and how they advise their patients related to the indication for the previous caesarean section. Responses were analysed according to age and gender. The questionnaire yielded a 68% response rate. None would counsel against labour unless there were contraindications. The majority would recommend labour for all indications for the previous caesarean section, although personal preferences were lower (p<0.04): 56% would recommend labour to their patients after a failed instrumental delivery, but only 36% would personally choose that option (p<0.002). Female obstetricians would contemplate and recommend labour more readily than males. Labour augmentation and induction was more frequently recommended (66% and 57%, respectively) than opted for personally (57% and 52%). Reluctance for labour augmentation and induction was greatest among younger consultants. While the majority of consultants favour labour for themselves and recommend this for their patients, it was reassuring to note that patients are encouraged to make the final decision. Informed patient choice is paramount and it is therefore important that full information about risks and benefits is available. [ABSTRACT FROM AUTHOR]

To correlate the severity of fetal distress assessed retrospectively using the Dublin intrapartum fetal monitoring classification, with decision-to-delivery intervals (DDI) and neonatal outcome, a prospective 3-month study of 78 consecutive instrumental deliveries was conducted. There were 66 cardiotocographs (CTGs) with an 83% majority agreement on classification: it was agreed 95% of deliveries should be expedited for the 58 interpretable CTGs. Although the more abnormal CTG patterns resulted in shorter DDIs and greater neonatal acidaemia, there were no significant correlations. Acidosis was present in 14% with a suspicious, or 22% an ominous CTG pattern. Delivery as a trial in theatre doubled the DDI at 41.5 ± 22.7 (mean ± SD) min, compared with 18.1 ± 8.1 min in the labour room (p < 0.0001), with one case of severe acidosis in the former group. The prolonged DDI with a trial of delivery in theatre could adversely compromise the already 'distressed' fetus and should be used only when clearly indicated. [ABSTRACT FROM AUTHOR]

This is a retrospective analysis of post-myomectomy pregnancies beyond 20 weeks' gestation in a teaching hospital for a 16-year period. There were 117 pregnancies, with complete data available for 112 pregnancies, in 81 women. A total of 92 deliveries followed myomectomy at laparotomy, 1 at laparoscopy and 19 at hysteroscopy. Of 72 labours, 22 were induced and 33 were augmented. Ten of those who laboured were delivered by caesarean section. The most common indication for intra-partum caesarean section was poor labour progress. There were no significant differences in neonatal outcome for babies delivered after labour compared with elective caesarean section. Maternal blood loss was however significantly higher with elective caesarean section (OR 2.01; 95% CI 1.96 - 2.06, p < 0.001). We report one uterine rupture at 36 weeks' gestation that followed laparoscopic myomectomy. These data do not support the view that myomectomy performed at laparotomy or hysteroscopy warrant avoiding labour or oxytocic administration. Laparoscopic myomectomy may be associated with a greater risk of scar rupture. [ABSTRACT FROM AUTHOR]

Using retrospective and prospective analyses of antenatal records, it was found that by 2003, discussions about the options for delivery after one lower segment caesarean section (LSCS) were almost always documented in antenatal notes, compared with only rare entries in 1993; specific mention of the risks of scar rupture were made in just under 50% in 2003. There was a considerable reduction in the proportion of women whose preference was to labour in 2003 compared with 1993 and also in the number who ultimately delivered vaginally. There was, however, no evidence that those women with whom possible scar rupture had been discussed were discouraged from attempting vaginal delivery. These data suggest that, contrary to expectations, increasing patients' involvement in their management in this situation does not result in fewer caesarean sections. [ABSTRACT FROM AUTHOR]

In this paper, we aimed to identify changes in the indications for and timing of caesarean section over 20 years. This involved a prospective data collection by clinical record analysis throughout the 12-month periods for 1976, 1986 and 1996. The study was carried out in the maternity unit of a large district teaching hospital. We studied all women delivered by caesarean section. Main outcome measures were rates for different indications for caesarean section for the populations served during each of the 3 years. Analysis of 1819 caesarean sections showed an increasing rate, from 6.7% in 1976 to 14.2% in 1996. The proportion of planned antepartum deliveries remained constant at 54%, with previous caesarean section given as the main indication in 1976 (55%) and 1986 (49%) and maternal request in 1996 (23%). Caesarean section for intrapartum fetal distress doubled over the study period, with little evidence of improved neonatal or long-term outcome. Caesarean section for failed labour induction and failed first- and second-stage progress all increased and for failed assisted delivery increased threefold. Caesarean section with a singleton breech presentation increased from 30% to 88% and for twin pregnancies from 13% to 47%. The rate of caesarean section for women delivered previously by section remained unaltered at 56%. The proportion of pregnancies delivered by caesarean section increased for virtually all indications. Consumer expectation has encouraged a more ready use of section, with maternal choice being the most frequent indication in 1996. [ABSTRACT FROM AUTHOR]

A questionnaire was used to assess patients' perception of and satisfaction with gynaecology outpatient appointment date and waiting times at gynaecology outpatient clinics. While 95% were satisfied with the overall service, 19% expressed dissatisfaction with waiting times for first appointment and 26% with the waiting time at the clinic. These findings are discussed in the light of the recommendations of the Patient's Charter and with respect to reorganising outpatient gynaecology services to improve efficiency. [ABSTRACT FROM AUTHOR]

In one health region between 1991 and 1996, 105 (11%) of all stillbirths were delivered by caesarean section. Fortyeight (46%) were unexpected at the time of birth, two of whom were macerated. Most of the macerated stillbirths were one of a multiple pregnancy, while 22 of the fresh stillbirths were delivered by caesarean section prior to the onset of labour. Twenty-one caesarean sections were performed because of failed attempts to induce labour, or at the request of the mother. The unexpectedly high rate of stillbirths delivered by caesarean section could be reduced by improved methods and understanding of antenatal and intrapartum fetal monitoring and techniques for inducing labour. [ABSTRACT FROM AUTHOR]

We examined the efficacy of follow-up, contact tracing and the need for retreatment in women who were screen-positive for genital tract Chlamydia trachomatis prior to termination of pregnancy. Eighty-six of 1363 (6.3%) women screened positive. These women were significantly younger than those who screened negative (P < 0.0001). The genitourinary medicine (GUM) clinic was notified of 73 (84.9%) screen-positive women and 41 (47.7%) attended for follow-up. Contact tracing was undertaken in 38 (92.7%) women who attended and 29 (70.7%) women who attended required retreatment for Chlamydia. The median duration between pregnancy termination and GUM clinic attendance was significantly longer in women who required retreatment compared to those who did not require retreatment (P = 0.003). In conclusion, follow-up and contact-tracing of women who screen positive for genital tract C. trachomatis was incomplete. This may substantially compromise the cost-effectiveness of a screen-and-treat programme. [ABSTRACT FROM AUTHOR]

Presents a case report of leiomyoma of the ovary. Signs and symptoms presented by the patient; Interventions done; Information on ovarian leiomyoma.