Outcome of the vaginal birth after cesarean section during the second birth order in West Kazakhstan.

BACKGROUND: Vaginal birth after cesarean section (VBAC) increases the chance of subsequent vaginal deliveries and reduces the repeat cesarean section (CS) rate with subsequent postoperative morbidity. OBJECTIVES: To detect the outcome of VBAC during the second birth order in Aktobe region of West Kazakhstan. PATIENTS AND METHODS: A total of 832 women eligible for trial of VBAC were included in this study. Women who signed the consent of VBAC were evaluated thoroughly and data such as maternal age, body mass index, height, gestational age at admission, indication of the previous CS, estimated fetal weight, engagement of the fetal head, condition of the membranes, and cervical dilatation were collected. Data collected after delivery include duration from active phase of labor, mode of delivery, fetal, and neonatal outcomes. The collected data analyzed to detect the outcome of trial of VBAC during the second birth order in Aktobe region of West Kazakhstan. RESULTS: Logistic analysis and odds ratio (OR) showed that body mass index (BMI) ≤25 kg/m2 (OR 1.7; P = 0.0004), height ≥150 cm (OR 1.7; P = 0.002), gestational age ≤40 weeks (OR 2.3; P = 0.0001), and inter-delivery interval ≥2 years (OR 1.6; P = 0.008) were significantly associated with successful VBAC. In addition, <2/5 of the fetal head palpable abdominally, station <-2 (OR 1.7; P = 0.0009), cervical dilatation ≥4 cm (OR 1.7; P = 0.003), and duration of active phase of labor ≤7 h (OR 1.6; P = 0.01) were significantly associated with successful VBAC. CONCLUSION: VBAC is safe in properly selected cases. BMI ≤25 kg/m2, gestational age ≤40 weeks, inter-delivery interval ≥2 years, and fetal head <-2 station increase the success of VBAC. Prolonged active phase of labor >7 h and the need for labor augmentation decrease the chance of VBAC success.

Post-test probability for pulmonary embolism after ventilation-perfusion scan assessed by nuclear medicine physicians.

OBJECTIVE: The objective of this prospective study was to compare assessments of pre- and post-ventilation-perfusion (V/Q) scan probabilities for pulmonary embolism (PE) by the nuclear medicine physician and the referring physician. MATERIALS AND METHODS: Seventy-nine patients (41 females, 38 males, mean age 49 years) referred for V/Q scans over a period of 6 months and suspected of PE were included in the study. The pre-test likelihood was determined independently by a consultant nuclear physician and a referring physician prior to the V/Q scan. The scan was performed according to a standard protocol using 8 view technetium-99m diethylenetriamine pentaacetic acid aerosol ventilation study followed by a technetium-99m macroaggregated albumin perfusion study. The scan was interpreted according to prospective investigation of pulmonary embolism diagnosis criteria. The post-scan probability was calculated. The probability of PE was quoted as low, intermediate and high. Agreement or disagreement in assessing the pre- and post-scan probability was classified according to the degree of difference (no difference: 0; minor difference: 1, and major difference: 2 grades). RESULTS: The agreement between the nuclear medicine and referring physicians on clinical probability of PE was moderate (63%) before the scan and good (90%) after the scan. The disagreement in assessing the clinical probability between the referring physician and the nuclear medicine physician was predominantly minor. Only 5 and 1% of the disagreement was major in pre-scan and post-scan probabilities, respectively. CONCLUSION: The data show that nuclear medicine physicians can use the assessment of pre-scan clinical likelihood to determine the post-scan probability of PE.

National Immunization Coverage Survey Saudi Arabia, 1991.

A nationwide survey was carried-out aiming at determination of immunization coverage level against the six killer diseases of childhood (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles). Variations between geographical zones, urban-rural settings, age, education and mother's employment, father's education, and child's birth order were studied. The standard WHO cluster technique was used. The sample (1102 children) was restricted to Saudi children 1-2 years old. Interviewers were exposed to training and methods of calibration, and involved in a pilot survey. Nationally, the survey showed very high coverage levels, BCG was the highest (99 per cent), measles was the lowest (90 per cent), whereas the three doses of DPT (diphtheria, pertussis and tetanus) and TOPV (trivalent oral polio vaccine) were in between (98, 96 and 94 per cent, respectively). There was no marked differences between urban-rural settings. The western zone showed the lowest coverage by all vaccines. The national coverage by the six vaccines reached 86 per cent correctly immunized (according to WHO standards), 14 per cent partially immunized and 1 per cent non-immunized. Immunization coverage was higher for children to younger mothers. The non-immunized group belonged exclusively to illiterate mothers (1 per cent). Children to mothers with basic education showed the highest coverage (88 per cent). Birth order had negative effect on coverage. Nationally, 88 per cent of children had immunization certificate while 12 per cent had not. The eastern and central zones had the highest percentages of children with certificates (92 and 91 per cent, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)