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Subject:	posts on VBAC moved from "Two Questions" under "home birth"
Body:	<div class="NTForums_Quote">Posted By Henci Goer on 07/10/2008 11:33 PM<br><DIV class=NTForums_Quote>Posted By Angela Simpson on 07/08/2008 2:34 PM <BR><BR>I do have a question unrelated to that though. I read recently somewhere that a study was done that concluded in only 0.7/1000 attempted VBACs resulted in rupture (or maybe it was .07%?). Has anyone else read this too, and if so, where did you find it??? I'm having a hard time finding it again. </DIV> <P><BR><BR>I think you're referring to the recently published study by <a target=_blank href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22American%20journal%20of%20obstetrics%20and%20gynecology%22%5BJour%5D%20AND%202008%5Bpdat%5D%20AND%20grobman%5Bauthor%5D" target=_blank><FONT color=#000080>Grobman S, et al. Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery. Am J Obstet Gynecol 2008; 199(1):e1-5</FONT></A>, which reported a rate of 7 per 1000 (which is the same as 0.7%) overall. In point of fact, many large studes have achieved scar rupture rates of 5 per 1000 (0.5%) or less. </P> <P>-- Henci</P> <P>_______________________________________________________________________</P> <DIV class=NTForums_Quote>Posted By Henci Goer on 07/09/2008 10:51 PM<BR> <DIV class=NTForums_Quote>Posted By Angela Simpson on 07/08/2008 2:34 PM <BR><BR>I do have a question unrelated to that though. I read recently somewhere that a study was done that concluded in only 0.7/1000 attempted VBACs resulted in rupture (or maybe it was .07%?). Has anyone else read this too, and if so, where did you find it??? I'm having a hard time finding it again. </DIV> <P><BR><BR>I think you're referring to the recently published study by <a target=_blank href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22American%20journal%20of%20obstetrics%20and%20gynecology%22%5BJour%5D%20AND%202008%5Bpdat%5D%20AND%20grobman%5Bauthor%5D" target=_blank><FONT color=#000080>Grobman S, et al. Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery. Am J Obstet Gynecol 2008; 199(1):e1-5</FONT></A>, which reported a rate of 7 per 1000 (which is the same as 0.7%) overall. In point of fact, many large studes have achieved scar rupture rates of 5 per 1000 (0.5%) or less. </P> <P>-- Henci</P></DIV> <P><BR><BR>I read the abstract that Henci linked to on this.  It is important to note that this study included women in whom labor was induced--it found that induction raised the risk of uterine rupture by 73%.  I believe the previous research showing a 0.5% rupture rate was for spontaneous labor...so it is highly likely that if we were to look at the full study, we might find the same kind of data in it.</P> <P>--Jenn</P> <P>_________________________________________________________</P> <P>I moved these from the "home birth & birth centers" topic because it belonged under VBAC. Thank you, Jenn, for pointing out the induction issue. I debated whether to bring it up and decided to just stick to the specific question asked. You are right, though. Most, although not all, studies find an increase in scar rupture rates with induction with prostaglandins (PGE2, misoprostol), oxytocin, or both. Augmentation often, although not always, increases risk as well. Differences probably depend on selection of candidates and dosage protocols.</P> <P>-- Henci</P></div><br><br>
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