ABSTRACT
This was a cross sectional study surveying a total of 451 physicians. A questionnaire was constructed and distributed electronically to the participants. The main outcome measure was evaluation of physicians' knowledge, attitude, and practice towards VBAC in Egypt. Although 76.3% of the physicians agreed to present VBAC as an option, 38.1% disagreed with encouraging it. Also, a large proportion of them advised against the induction of labour and refused it if post-term (69.4% and 76.1%, respectively). The physicians' attitude towards VBAC was to allow vaginal birth if the patient went into spontaneous labour (72.3%) and perform repeat CS if not in labour (86.7%). Fear of complications (78.71%) was the most common cause of not conducting VBAC. The consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. Impact StatementWhat is already known on this subject? This is the first study to evaluate physicians' knowledge, attitude, and practice towards VBAC in Egypt and the Arab world.What do the results of this study add? From the current survey of the practice of the obstetricians in Egypt, the consensus of practice was to present VBAC as an option for women with a single Caesarean scar; however, one-third of them did not encourage VBAC. They strongly refused the induction of labour. The presence of labour pain is the strongest determinant to allow VBAC, while the vast majority of obstetricians were willing to conduct ERCS in the absence of labour pain. This contributed significantly to the rising rates of CS in Egypt.What are the implications of these findings for clinical practice and/or further research? Physicians' attitude towards VBAC should be evaluated in countries with higher rates of CS deliveries. Women's perspectives and attitude towards VBAC should be evaluated.
Subject(s)
Labor Pain , Physicians , Vaginal Birth after Cesarean , Cesarean Section, Repeat , Cicatrix , Cross-Sectional Studies , Egypt , Female , Health Knowledge, Attitudes, Practice , Humans , PregnancyABSTRACT
BACKGROUND: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. METHODS: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions. RESULTS: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). CONCLUSION: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.
