Comments on: The Role of Interpretation – ACOG Refines Fetal Heart Rate Monitoring Guidelines

By: Jenn

Jenn — Fri, 04 May 2012 17:31:53 +0000

Thank you! Oh yes I know about placenta accreta. I am in the situation where my first c-section was medically necessary (severe pre-eclampsia/beginning HELLP) but the hospital/OB was very anti-vbac, so I had to change both to find a vbac friendly environment, but my husband picked up from the previous environment that vbac’s are dangerous and my having to change doctors and hospital makes him nervous. Outlining the risks of other things that can go wrong during any vaginal delivery makes uterine rupture not stand out so much as the worst thing in the world or a reason not to try for a vbac.
I do have the NIH statement on hand, and also the Department of heath and human services evidence report which gathered the background evidence for the NIH conference – actually I didn’t see it on your resource website, so here that is as well (though I’m sure it’s in your stash somewhere!). I haven’t made it through the whole report yet (400 pages) but what I have read is really interesting.

http://www.ahrq.gov/downloads/pub/evidence/pdf/vbacup/vbacup.pdf

Thank you again!

By: Jen Kamel

Jen Kamel — Thu, 03 May 2012 06:27:02 +0000

Hi Jenn! Thanks for the link update. ACOG updated their website a couple years ago so many of the older links I provide here no longer work. I believe the chart you are looking for can be found in an article written by two OBs protesting a VBAC ban at their local rural hospital. I'm sure you already know, but for the benefit of future readers, I want to point out that the incidence of obstetrical complications does not necessarily reflect the rates of infant or maternal morbidity/mortality. Take placeta accreta which I talk about quite a bit. The risk is very low for a first time mom (less than 0.5%), but increases with each subsequent cesarean. The risk of maternal mortality for accreta has been reported around 7-8%. That is significant. If you want the latest and greatest information on VBAC, I recommend you check out the Guise 2010 Evidence Report, the National Institutes of Health's VBAC Statement, as well as the many presentation videos from the 2010 NIH VBAC Conference. You can access all of these resources here. Warmly, Jen

By: Jenn

Jenn — Thu, 03 May 2012 04:55:06 +0000

Very interesting! Thank you for this incredibly resource heavy website. For that, here’s the updated link to the ACOG publication:

http://www.acog.org/About_ACOG/News_Room/News_Releases/2009/ACOG_Refines_Fetal_Heart_Rate_Monitoring_Guidelines

I thought I had found an article here about the rate of uterine rupture as compared to other obstetrical emergencies in tabular form to compare the rate and maternal and neonetal risk of each, but I am unable to find it now. Do you have that information?

Thank you!

By: It’s Distressing « Woman to Woman Childbirth Education

It’s Distressing « Woman to Woman Childbirth Education — Thu, 16 Jul 2009 00:11:09 +0000

[...] they are seeing!!” [That may be what Pinky was referring to in this post. And fwiw, here is one post and another post on ACOG's refining fetal heartrate monitoring guidelines.] The second post has [...]