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Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

In our group, associated malformations were the main factor affecting the long-term quality of life of children with omphalocele and gastroschisis. Although most of the children were developing normally, fear of a repetition of the malformation in a subsequent pregnancy dominated reproductive choices in all couples.

!1. The vast majority of affected pregnant women fulfil conditions for an attempted vaginal birth after caesarean section (VBAC) and should be counselled accordingly (ACOGLevel 1). This is particularly true after one previous caesarean and for singleton pregnancies with cephalic lie and gestational age beyond 37 completed weeks (RCOG -Grade B).2. Women should be informed that the success rate for VBAC is between 60-85 % (SOGC, ACOG, RCOG -Grade C). 3. Women should be informed that a successful vaginal birth is associated with the lowest complication rate (RCOG-Grade B). 4. Women should be informed that occasionally, in the event of unsuccessful vaginal delivery, an urgent caesarean section is necessary and this is associated with an increased complication rate (RCOG -Grade B). Abstract !The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patientʼs wishes into account. In view of good success rates (60-85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician. Zusammenfassung Labour and Childbirth After Previous Caesarean SectionRecommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG)Geburt nach vorausgegangenem Kaiserschnitt

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