Labour and Childbirth After Previous Caesarean Section: Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG)

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 patient's 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.

The Decreasing Length of Hospital Stay following Vaginal Hysterectomy: 2011-2012 vs. 1996-1997 vs. 1995-1996

Background/Definition of the Problem: In recent years, postoperative management has changed towards rapid mobilisation, early oral feeding and rapid rehabilitation (known as Fast-Track or Enhanced Recovery Concepts). This study analysed the postoperative length of stay after vaginal hysterectomy in 3 different periods of time. Material and Methods: In the period October 2011 - September 2012, 75 patients underwent vaginal hysterectomies (± adnexectomy); another 114 vaginal or laparoscopic hysterectomies with additional operations (e.g. prolapse surgery and incontinence surgery) and malignancies were not included. The time periods August 1995 - July 1996 (n = 50) and October 1996 - September 1997 (n = 96) served as a comparison. Reducing the length of stay was not an explicit goal. Results: The median postoperative stay was shortened from 7 (5-9) to 5 (3-15) or 3 (0-5) days (p < 0.001). The recovery rate remained unchanged at 2.7 % (n = 2), cf. 2 % (n = 1) and 3.1 % (n = 3). In 40/75 cases (53.3 %), the surgery took place on the day of admission. Conclusion: The length of hospital stay after vaginal hysterectomy has more than halved since 1995/1996 and continues to decline. This development occurred without a shortened stay being an explicit goal of the clinic. The shortened length of stay does not appear to have a negative impact on postoperative complications and recovery rate.

[Foetal scalp blood sampling: impact on the incidence of Caesarean section and assisted vaginal deliveries for non-reassuring foetal heart rate and its use according to gestational age]

BACKGROUND

Interpretation of a suspicious, non-reassuring or pathological foetal heart rate tracing does not provide any direct information about foetal oxygen saturation, blood gas status or the extent of changes in pH. Without foetal scalp blood sampling, such tracings often necessitate rapid intervention to deliver the baby by Caesarean section or assisted vaginal delivery. The aim of this study was to show the impact of foetal blood sampling on reducing the number of Caesarean sections and assisted vaginal deliveries in a clinical setting in such cases.

MATERIALS AND METHODS

A retrospective study of the mode of delivery in 669 women where foetal scalp blood sampling had been performed for suspicious or pathological foetal heart rate monitoring, in the period 2008-2009 was undertaken. The gestational age of the foetus was also investigated.

RESULTS

Because one or more results of foetal scalp pH were within the normal range an operative delivery could be avoided in 6.4% of the study population, in spite of the non-reassuring foetal heart rate monitoring. Foetal blood sampling was performed more frequently in post-term pregnancies.

CONCLUSIONS

Foetal blood analysis still is an effective tool to reduce unnecessary operative deliveries and should be regularly included in intrapartum monitoring. The risk of foetal complications is low compared with the reduction in the rate of Caesarean sections and assisted vaginal deliveries. Obstetricians are evidently becoming more willing to carry out foetal scalp blood sampling with rising gestational age.