The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation 英文参考文献.docVIP

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The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation 英文参考文献.doc

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The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation 英文参考文献

WanyonyiandKarugaBMCPregnancyandChildbirth2010,10:62 /1471-2393/10/62 RESEARCH ARTICLE OpenAccess Theutilityofclinicalcarepathwaysin determiningperinataloutcomesforwomenwith onepreviouscaesareansection;aretrospective serviceevaluation SikoliaZWanyonyi1*,RobinsonNKaruga2 Abstract Background:Therisingratesofprimarycaesareansectionhaveresultedinalargerobstetricpopulationwith scarreduteri.Subsequentpregnanciesinthesewomenarerisk-proneandmaycomplicate.Besidesensuring standardisedmanagement,carepathwayscouldbeusedtoevaluateforperinataloutcomesinthesehighrisk pregnancies.Weaimtodemonstratetheuseofacarepathwayforvaginalbirthaftercaesareansectionasa serviceevaluationtooltodetermineperinataloutcomes. Methods:Aretrospectiveserviceevaluationbyreviewofdeliverycasenotesandrecordswasundertakenatthe AgaKhanUniversityHospital,Nairobi,KenyabetweenJanuary2008andDecember2009 Womenwith≥2previouscaesareansections,previousclassicalcaesareansection,multiplegestation,breech presentation,severepre-eclampsia,transverselie,placentapraevia,conditionsrequiringinductionoflabourand incompleterecordswereexcluded.Outcomemeasuresincludedtheproportionofeligiblewomenwhooptedfor testofscar(ToS),successrateofvaginalbirthaftercaesareansection(VBAC);proportiononwomenoptingfor electiverepeatcaesareansection(ERCS)andtheirperinataloutcomes. Results:Atotalof215womenwithonepreviouscaesareansectionwerefollowedupusingastandardcare pathway.Themedianparity(minimum-maximum)was1.0[1-4].Theotherdemographiccharacteristicswere comparable.Only44.6%ofeligiblemothersoptedtohaveaToS.ThesuccessrateforVBACwas49.4%withthe commonest(31.8%)reasonforfailurebeingprotractedactivephaseoflabour.Maternalmorbiditywascomparable forthefailedandsuccessfulVBACgroup.Theincidenceofhemorrhagewas2.3%and4.4%forthesuccessfuland failedVBACgroupsrespectively.TheproportionofbabieswithacidoticarterialPH(7.10)was3.1%and22.2% amongthesuccessfulandfailedVBACgroupsrespectively.Noperinatalmortalitywasreported. Conclusions:Besidesensuringstandardisedmana