BackgroundThe purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population.MethodsExtraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004–2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s).ResultsAmong 53,479 different women admitted to labor and delivery ward, 43% of women reported having had 1 or more first trimester spontaneous miscarriages; 27% reported having had one, 10% two, 4% three, 1.3% four, 0.6% five and 0.05% reported having 6–16 spontaneous first trimester miscarriages. 18.5% had one or more first trimester miscarriages before their first live birth. Eighty-one percent of women with 11 or more living children experienced one or more first trimester miscarriages. First trimester miscarriage rates rose with increasing age, increasing parity, after previous ectopic pregnancy, after previous cesarean surgery, with any smoking during pregnancy and pre-pregnancy BMI ≥30.ConclusionsMiscarriages are common among parous women; 43% of parous women report having experienced one or more first trimester spontaneous miscarriages, rising to 81% among women with 11 or more living children. One in every 17 parous women have three or more miscarriages. Depending on her health, nutrition and lifestyle choices, even a 39 year old parous woman with a history of 3 or more miscarriages has a good chance of carrying a future pregnancy to term but she should act expediently.

Amniotomy has become a routine part of obstetrical care. It was added along with other procedures adopted 50+ years ago without strong evidence. The scientific data supporting this procedure is poor while there is data suggesting it may increase the frequency of cord prolapse, neonatal GBS infection, pain and fetal blood loss if placental blood vessels are punctured. The incidence of cord prolapse overall reported in the literature ranges from 0% to 0.7%. The rate at which cord prolapse immediately follows amniotomy has not been directly studied but is reported in 4 case controlled studies.

No abstract

Vaginal birth after caesarean section versus elective repeat caesarean section: assess neonatal downstream outcomes too Sir, We were interested in the article by Pare et al. 1 showing an excess increase in hysterectomy in subsequent pregnancies for women having elective repeat caesarean sections. Further valuable information is added to the risk assessment which women, obstetricians and midwives must make; both when considering a primary caesarean section or waiting for labour in a subsequent pregnancy. The National Institute of Clinical Excellence has examined the health risks of caesarean section and concluded that, even for a first caesarean section, maternal request alone is not an indication for elective major surgery and requires the use of counselling to explore women's motives and a second opinion, 2 because of the imbalance of health risks to mothers and babies which only widens with increasing parity and increasing numbers of caesarean sections. It is generally better to labour 852 ª

No abstract