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October 2010, Volume 40 Number 10 , p 19 - 21



Attempting a vaginal birth after cesarean (VBAC) is a "safe and appropriate choice" for most women who've had a cesarean delivery—even some who've had two previous cesareans. New guidelines from The American College of Obstetricians and Gynecologists ease previous restrictions on who can safely attempt VBAC and aim to reduce the rate of cesarean deliveries.Cesarean deliveries rose dramatically between 1970 and 2007, from 5% to more than 31%. In contrast, rates for VBAC, which were 28% in 1996, dropped to about 9% in 2006. These trends reflect restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC), and decisions by patients after learning of the risks and benefits. Besides some women with two previous low-transverse cesarean incisions, those carrying twins and those with an unknown type of uterine scar are also appropriate candidates for TOLAC.The guidelines recommend more thorough counseling about the benefits and risks of VBAC and emphasize the importance of patient autonomy.Source: The American College of Obstetricians and Gynecologists. Practice Bulletin No. 115: Vaginal Birth after Previous Cesarean Delivery. Obstet Gynecol. 2010;116(2, part 1):450–463.A new report concludes that sepsis and septic shock after general surgery are more common than pulmonary embolism and myocardial infarction. Based on records of nearly 363,900 patients having general surgery, the incidence of these complications was as follows: * sepsis, 2.3% * septic shock, 1.6% * pulmonary embolism, 0.3% * myocardial infarction, 0.2%.Mortality for patients with septic shock was 34% within 30 days of surgery. Risk factors for mortality include age older than 60, having emergency surgery, and the presence of any comorbidity, which increased the risk of sepsis and septic shock sixfold.Researchers say their findings support the need for "early recognition of patients at risk via aggressive screening and the

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