National survey of obstetricians in Wales regarding induction of labour in women with a previous caesarean section

Abstract

We conducted a national survey of consultants in Wales to elicit the opinions on induction of labour in women with a previous caesarean section. A total of 65 of the 87 consultants returned the postal questionnaire (75% response rate) and 54 of them were practising obstetricians. All but one obstetrician (53/54) would consider induction and for post-term indication, 47/53 would offer induction to a woman with a previous section; 40/53 (75%) of obstetricians would consider the prostaglandin method. The majority (36/40) would use prostaglandin tablets/gel; 80% (29/36) would use up to 2 doses (maximum recommended) and two-thirds (36/54) would consider syntocinon for augmentation of labour. A total of 34/54 (63%) consultants felt that Bishop's score would influence their decision to offer induction of labour (IOL) in a woman with one previous section and some 88% (47/53) of obstetricians always mentioned the increased risk of caesarean section and uterine rupture to these women during counselling before offer of induction. In conclusion, our survey reveals the variation in approach to management of postdates in women with previous caesarean section. We recommend a national audit of induction of labour in women with previous caesarean section.

Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success

“…In this population, we did not observe the decline in attempted VBAC rates that has been reported in other developed countries . The rate of attempted VBAC during the timeframe of this study (52.2%) is considerably higher than that in the USA, where it was estimated recently that 20% of women choose this option, but slightly lower than in several European countries, where rates of up to 70% have been reported . These differences in national rates are likely to arise from a combination of factors, including the type of healthcare system, patient preferences and the extent to which national clinical guidelines recommend VBAC.…”

“…[3][4][5][6] The rate of attempted VBAC during the timeframe of this study (52.2%) is considerably higher than that in the USA, where it was estimated recently that 20% of women choose this option, 3,45 but slightly lower than in several European countries, where rates of up to 70% have been reported. [46][47][48][49][50][51] These differences in national rates are likely to arise from a combination of factors, including the type of healthcare system, patient preferences and the extent to which national clinical guidelines recommend VBAC. The current VBAC guidelines produced by the American College of Obstetricians and Gynecologists mandate that an obstetrician and anaesthesiologist be 'immediately available' during a trial of labour and restrict the availability of VBAC in community and rural hospitals.…”

International Variations in a Selected Number of Surgical Procedures

“…One regional study from France supports the same conclusion on the determinants of within-country variation (Rabilloud et al, 1998). Evidence from a study conducted in Wales on the opinion on induction of labour on women who previously had a caesarean section suggests that some of the emergency section variation could be explained by differences in medical opinion (Udayasanikar et al, 2008). The role of diagnosis is also recognized by a study of inter-hospital variation during 1994-1995 in Valencia, Spain.…”

Pregnancy outcomes of induced labor in women with previous cesarean section: a systematic review and meta-analysis

“…Since a previous cesarean section is often an exclusion criterion in randomized controlled trials (RCTs) on IOL, a recent Cochrane review was only able to include two RCTs involving a total of 80 women, which compared different methods of IOL, but not induced vs. spontaneous labor [6]. Therefore, it is not surprising that both Udayasankar et al [7] and Gupta et al [8], by performing a national survey, reported a wide variation in practice of IOL at term or postterm in women with a previous cesarean section.…”