Caesarean Section on Request: A Comparison of Obstetricians??? Attitudes in Eight European Countries

Abstract

This study was a small-scale, "quasirandomized," controlled trial carried out to determine the effectiveness and safety of cervical cerclage performed using the McDonald technique in patients with symptomatic placenta previa. Outcomes were compared in 18 women undergoing cerclage and 19 control women. Criteria for admission to the study included painless vaginal bleeding, a gestational age of 20 to 34 weeks, and sonographic confirmation of the diagnosis. Gross congenital anomalies, other complications, type 1 placenta previa more than 2 cm from the internal os, and a cervical length less than 3 cm, noted on speculum examination 24 hours after bleeding stopped, were criteria for exclusion.Patients were placed on bedrest, sedated if bleeding was present, and given steroids weekly from 28 to 34 weeks gestation. Blood was transfused as needed. The McDonald stitch was placed under antibiotic prophylaxis and tocolysis that began 1 hour before cerclage and continued for 48 hours postoperatively. If placenta previa was characterized as "minor," patients were discharged 3 days after cerclage. Pregnancies were terminated at 37 weeks gestation.All but one of the end points recorded differed significantly between the cerclage and control groups, the exception being the amount of blood transfused. Cerclage patients had fewer major hemorrhagic episodes and fewer episodes associated with blood clots or signs of hypovolemia. In none of 10 patients with minor placenta previa who had cerclage and subsequent normal-term vaginal delivery was the placenta felt on pelvic examination after removal of the stitch. Pregnancies were prolonged by a mean of 53 days in the cerclage group and 19 days in control women. The respective mean gestational ages at delivery were 37 and 31 weeks. Mean birth weights were substantially greater in the cerclage group (2549 g vs 1568 g). Eight of the 19 control pregnancies ended in perinatal death, but there were no such deaths in the 18 cerclage cases.These promising results deserve a large randomized, controlled trial that would distinguish between the effect of cerclage in women with minor and major placenta previa.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

“…Concerning reliability, Test-retest was not performed in this study as parts of the questionnaire had been used successfully in previous studies (Cuttini et al, 2006;Habiba et al, 2006). The questionnaire consisted of different parts.…”

“…Each responsible coordinator was required to ensure that this deadline was met. The midwives were recruited from the same Swedish units that participated in the EUROBS study: (Development of Perinatal Technology and Ethical Decision-making during Pregnancy and Birth; the attitudes of obstetricians from eight European countries) (Cuttini et al, 2006;Habiba et al, 2006). The heads of three units refused to give their consent, due either to reorganisation, a heavy workload or shortage of time.…”

“…The questionnaire in the SWEMID-project was the same as the questionnaire used in the EUROBS project (Cuttini et al, 2006;Habiba et al, 2006). This questionnaire was developed in English, translated into Swedish and then back-translated into English (ibid).…”

The impact of the mass media on obstetricians’ behavior in Norway

“…Obstetricians might take the mother's preferences into account when deciding on mode of delivery [26,27]. Previous research has shown that these preferences are determined to a large extent by mothers' level of education and their immigrant background [22,28,29]. Equation (1) was specified as a linear probability model, where the standard errors were clustered on hospital [30].…”

A Comparison Between Swedish Midwives and Obstetricians & Gynecologists Opinions on Cesarean Section

“…The reasons for this increase are also matters of concern and are under analysis both from a medical and a public perspective since the "women's own choice" or cesarean on "maternal request" is thought to be the major reasons for the increase (1)(2)(3). Among the general public there is an agreement that women have the right to choose both on the basis of concern with bodily integrity and because of fear of childbirth (4).…”