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This article discusses the risk factors and outcomes associated with VBAC (Vaginal Birth After Cesarean) deliveries, including statistics on uterine rupture, induction methods, and potential complications. It also explores the debate around elective repeat cesarean versus VBAC, as well as the impact of single-layer closure on uterine rupture rates. Additionally, the text delves into the rise in diabetes cases globally, focusing on the prevalence among Asians and the implications for pregnancy. Furthermore, it provides updates on HIV prevention in newborns and the benefits and potential drawbacks of antenatal corticosteroids. The article concludes with a tribute to India's first test-tube baby and her reflections on being a pioneering figure in the field of assisted reproduction technology.
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ObG Watch October 2003
VBAC – Is the risk acceptable? • Overall Risk of Rupture Uterus: 4.5/1000 • Induction with PG: 24.5/1000 • Induction without PG: 5.2/1000 • PNM & Low Apgar: 11 times higher • No method to measure probability of success - Lydon & Rochelle: Data on >20000 women in Washington state – N Eng J Med
"What is safe for my baby?" -Patient with Prev CS "My unequivocal answer is Elective Repeat CS!" -MF Greene New Eng J Med
Are all roads leading to CS?-Guest Editorial:ObGynSurv Vol56 No10 • ACOG Guidelines are so stiff that many Hospitals & Practitioners have stopped offering VBAC in US • Patients with prev CS present late in labour in the hope of VBAC • Risk of Rupture Uterus at home has climbed
"Single-layer closure of Uterine Incision increases risk of Rupture 6 times" (3.1% Vs 0.5%) Meta analysis Am J ObG
Say cheese! “It is remarkable that a newborn baby does not smile for 6 weeks, but smiles frequently in utero.” - Prof. Campbell
The scourge of Diabetes • 177 Million suffer from Diabetes in the World (WHO) • 20% are Indian • Asia’s count will hit 170 million by 2025 • India & China will account for 100 million - IDI (International Diabetes Institute)
Why Asians? • Genetically prone to Insulin Resistance Syndrome • “Thrifty Genes” enabled survival during famine by storing fat in the abdomen • Changing Life style & Food habits
Pregnancy& Diabetes • 5% of all Pregnant women are Diabetic • First Trimester Screening picks up Early onset GDM & Unrecognized Type II DM (30%) • Early onset GDM carries higher risk of Hypertension, Increased need for Insulin, Neonatal Hypoglycemia & Perinatal Death • Mx same as Pregestational Type II Diabetes
HIV update “Nevirapine is superior to Zidovudine in preventing Vertical Transmission to Babies born to HIV+ Mothers and Breast-fed by them” -HIVNET Trial Uganda - Reported in Lancet
Antenatal Corticosteroids The Good: • Improves Resp Function – Reduces RDS • Beneficial in even PPROM • Protects from Ventricular Haemorrhage • Halves the risk of Ventriculomegaly & Cerebral Palsy • Less need for Volume expansion & Vasopressor • Improves survival & Increases IQ
Antenatal Corticosteroids The Bad • Reduction of Brain Weight • Inhibits Myelination • Suppresses Cortisol Secretion • Adverse development of Blood-Brain Barrier • Rise in Fetal BP • Predisposes to Diabetes later
Antenatal Corticosteroids The Unknown: • Advantage of Second Dose? • Role of Intra amniotic Injection? -Newnham et al: Current Opinion in ObG Jan 2003
India's First Test-tube Baby Durga alias Kanupriya was in Bangalore on October 3 for the 28th Anniversary of the World’s First IVF-ET She said, “I often feel like Edison’s Bulb”
