Seminars in Perinatology RSS feed: Current Issue. The purpose of each issue of Seminars in Perinatology is to provide authoritative and comprehensive reviews of a single topic of interest to professionals who care for the mother, the fetus, and the newborn. The journal's readership includes perinatologists, obstetricians, pediatricians, epidemiologists, students in these fields, and others. Each issue offers a comprehensive review of an individual topic, with emphasis on new developments that will have a direct impact on their practice. 2010 Topics , Volume 34, Issues 1-6 February Advances in Neonatal Neuroimaging Catherine Limperopoulos, MD April Newborn Screening Bradford Therrell, Jr, PhD June Neonatal Update William Oh, MD August Consensus Conference on VBAC-Part I Caroline Signore, MD, MPH October Consensus Conference on VBAC-Part II Caroline Signore, MD, MPH December Global Perinatal Health Gary Darmstadt, MDhttp://www.seminperinat.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Seminars in Perinatology0146-0005344August 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.seminperinat.com/article/PIIS0146000510000571/abstract?rss=yesCover10.1053/S0146-0005(10)00057-1Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0OFCOFChttp://www.seminperinat.com/article/PIIS0146000510000583/abstract?rss=yesMasthead10.1053/S0146-0005(10)00058-3Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0IFCIFChttp://www.seminperinat.com/article/PIIS0146000510000595/abstract?rss=yesTable of Contents10.1053/S0146-0005(10)00059-5Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0iihttp://www.seminperinat.com/article/PIIS0146000510000601/abstract?rss=yesTopics for 200910.1053/S0146-0005(10)00060-1Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0iiiihttp://www.seminperinat.com/article/PIIS014600051000025X/abstract?rss=yesIn 1980, amid concern over increasing cesarean delivery rates, the National Institute of Child Health and Human Development sponsored a Consensus Development Conference on cesarean childbirth, at which the consensus panel found vaginal birth after cesarean (VBAC) to be a reasonable alternative to repeat cesarean for many women. By 1996, VBAC rates had increased to more than 28%, but the increase was short lived, such that VBAC accounts for fewer than 8% of births after cesarean today. The reasons for this shift are not entirely understood but likely include concerns about potentially serious complications of VBAC attempts, as well as nonmedical factors, such as administrative policies, medicolegal pressures, professional society guidelines, and patient and provider preferences.Vaginal Birth After Cesarean: New Insights Manuscripts from a National Institutes of Health Consensus Development Conference, March 8-10, 2010Caroline Signore, Catherine Y. Spong10.1053/j.semperi.2010.03.001Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0235236http://www.seminperinat.com/article/PIIS0146000510000261/abstract?rss=yesA review of the literature and analysis of the National Inpatient Sample Database was performed to describe the trends in vaginal birth after cesarean availability in the United States and the factors associated with changing use. Vaginal birth after cesarean increased after the first National Institutes of Health Consensus Conference on Cesarean Childbirth in 1981. It increased from 3% to a maximum rate of 28.3% in 1996. Despite studies reporting stable success rates of approximately 70% and low complication rates (<1%), concerns about patient safety and physician liability have led to more restrictive policies and a decrease in vaginal birth after cesarean use. The current rate is approximately 8.5%, and decreased rates have been noted for all age and ethnic groups. There is decreased use of vaginal birth after cesarean as the result of concerns about patient safety and physician liability, which has resulted in decreased availability.Trends and Patterns of Vaginal Birth After Cesarean Availability in the United StatesKimberly D. Gregory, Moshe Fridman, Lisa Korst10.1053/j.semperi.2010.03.002Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0237243http://www.seminperinat.com/article/PIIS0146000510000273/abstract?rss=yesThere have been multiple observational studies that have assessed the probability that a woman who undertakes a trial of labor after a previous cesarean delivery will have a vaginal birth. These studies have demonstrated a population-level probability of a successful vaginal birth after cesarean (VBAC) that ranges between 60% and 80%. However, within a population the chances for success of a given individual may vary to a significant degree on the basis of particular demographic characteristics and obstetric history. This review summarizes the different characteristics that have been prominently associated with successful VBAC as well as the different attempts that have been made to develop accurate prediction models for successful VBAC.Rates and Prediction of Successful Vaginal Birth After CesareanWilliam A. Grobman10.1053/j.semperi.2010.03.003Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0244248http://www.seminperinat.com/article/PIIS0146000510000285/abstract?rss=yesAn estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman’s health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.Birth After Previous Cesarean Delivery: Short-Term Maternal OutcomesMona T. Lydon-Rochelle, Alison G. Cahill, Catherine Y. Spong10.1053/j.semperi.2010.03.004Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0249257http://www.seminperinat.com/article/PIIS0146000510000303/abstract?rss=yesMost studies of cesarean morbidity focus on short term, rather than long term complications. However, women undergoing cesarean delivery are at increased risk for a chronic problems as well. These include pain and surgical adhesions, as well as a possible increased risk for infertility or sub-fertility and perinatal complications in subsequent pregnancies. The most serious risk for women undergoing multiple repeat cesarean deliveries is a dramatically increased risk for life threatening hemorrhage and morbidity in the setting of placenta accreta. This chapter outlines these long term risks of cesarean delivery so that they may be factored into the risk:benefit ratio for women considering vaginal birth after cesarean delivery (VBAC).Delivery After Previous Cesarean: Long-Term Maternal OutcomesRobert M. Silver10.1053/j.semperi.2010.03.006Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0258266http://www.seminperinat.com/article/PIIS0146000510000297/abstract?rss=yesUterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk.Predicting Uterine Rupture in Women Undergoing Trial of Labor After Prior Cesarean DeliveryMark B. Landon10.1053/j.semperi.2010.03.005Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0267271http://www.seminperinat.com/article/PIIS0146000510000315/abstract?rss=yesWomen must often choose between a vaginal birth after previous cesarean and elective repeat cesarean delivery. Short-term risks of vaginal birth after cesarean can be potentially catastrophic in the setting of uterine rupture. Although randomized controlled trials comparing these 2 modes of delivery are lacking, observational studies suggest an increased risk of perinatal mortality and hypoxic-ischemic encephalopathy in infants whose mothers undergo a trial of labor. These rare risks compete with more common, albeit less severe, short-term risks associated with elective repeat cesarean delivery, with a particular emphasis on increased respiratory morbidities. Further studies are needed to identify potential strategies to improve perinatal outcomes and help guide physicians and patients in choosing optimal methods of delivery.Delivery After Previous Cesarean: Short-Term Perinatal OutcomesRavi M. Patel, Lucky Jain10.1053/j.semperi.2010.03.007Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0272280http://www.seminperinat.com/article/PIIS0146000510000327/abstract?rss=yesIn subsequent pregnancies after a cesarean delivery, women must choose between attempting to deliver vaginally or undergoing another cesarean delivery. Information relevant to this choice includes the long-term benefits and harms to the baby. In this article we discuss the relationship of mode of delivery (planned trial of labor, either with or without vaginal delivery, or elective repeat cesarean delivery) and long-term outcomes, including brachial plexus palsy, neurodevelopmental impairment, and asthma. No randomized trials are available that relate directly to the choice of delivery method after previous cesarean. Observational studies suggest that cesarean delivery might be associated with a greater risk of asthma, caused perhaps by altered gut colonization, increased risk of neonatal respiratory disease, decreased gestational age at birth or decreased likelihood of breastfeeding. By contrast, vaginal delivery after a previous cesarean delivery is associated with greater risks of neurodevelopmental impairment and upper-extremity motor impairment, caused, respectively, by greater risks of perinatal hypoxic-ischemic encephalopathy and brachial plexus injury. Available information does not provide a precise estimate of the relative risks for infants delivered after a trial of labor versus elective cesarean delivery.Delivery After Previous Cesarean: Long-Term Outcomes in the ChildT. Michael O'Shea, Mark A. Klebanoff, Caroline Signore10.1053/j.semperi.2010.03.008Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0281292http://www.seminperinat.com/article/PIIS0146000510000479/abstract?rss=yesVaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s suggested that this practice may not always be necessary. In 1980, a National Institutes of Health (NIH) Consensus Development Conference Panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to have a trial of labor was offered and exercised more often in the 1980s through 1996. Since 1996, however, the number of VBACs has declined, contributing to the overall increase in cesarean delivery (). Although we recognize that primary cesarean deliveries are the driving force behind the total cesarean delivery rates, the focus of this report is on trial of labor and repeat cesarean deliveries.National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean: New Insights March 8–10, 2010National Institutes of Health10.1053/j.semperi.2010.05.001Seminars in Perinatology 34, 4 (2010)2010-08-01Seminars in Perinatology2010-08-01344S0146-0005(10)X0004-0293307