This blog is a follow-up to our March 3 blog where we announced the NIH Consensus Development conference scheduled on March 8-10 to discuss the safety issues surrounding vaginal birth after previous Cesarian section. AHRQ has released a report from that meeting that found that vaginal birth after cesarean section is a safe and reasonable choice for a majority of women. Each year, more than 1 million cesarean surgeries are performed, and in 2007 nearly one in three births was cesarean in the U.S. A steady increase in repeat cesarean births over the past decade has been attributed, in part, to studies that suggested there may be significant harms associated with vaginal birth after cesarean section. Investigators found evidence which showed that while rare, maternal mortality was significantly higher for elective repeat cesarean versus trial of labor. Additionally, risks for uterine rupture and perinatal death remain rare, but elevated for trial of labor. Other important outcomes such as hemorrhage/transfusion, adhesions, surgical injury, and wound complications remain uncertain due to lack of consistent definition and reporting. Moreover, investigators also found increasing evidence that women with multiple cesarean deliveries were at significant risk of life threatening conditions. Led by Jeanne-Marie Guise, M.D., M.P.H., researchers note that evidence-based research regarding factors, such as medical liability, economics and hospital staffing that may influence patient, provider and hospital-related decisions between both types of delivery is not sufficient. The report, Vaginal Birth After Cesarean: New Insights, was conducted by AHRQ’s Oregon Health and Science University Evidence-based Practice Center and was prepared for the NIH Consensus Development Conference held on March 8-10. Click here to review the entire draft report.
Vaginal birth after cesarean (VBAC) is the delivery of a baby through the vagina after a previous cesarean delivery. For most of the 20th century, clinicians believed that once a woman had undergone a cesarean, all of her future pregnancies required delivery by that procedure as well. In the 1980s, vaginal birth after cesarean (VBAC) also began to be considered a viable option for these women. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising. What accounts for these changing practice patterns? An improved understanding of the clinical risks and benefits of both procedures, and how these risks interact with legal, ethical, and economic forces to shape provider and patient choices about VBAC, may have important implications for health services planning and informed decisionmaking.
An impartial, independent, Consensus Development Conference panel will hold a press telebriefing to discuss their findings and implications for the public following the NIH Consensus Development Conference on Vaginal Birth After Cesarean (VBAC): New Insights, March 8-10, 2010. The panel’s statement will incorporate their assessment of the available evidence from a systematic literature review, expert presentations, and audience input to inform patient and provider decisions regarding VBAC.
This blog site will post a summary once the guidelines are released.
According to a study that was coordinated by investigators at Northwestern University's Feinberg School of Medicine, two to three times more pregnant women may soon be diagnosed and treated for gestational diabetes, based on new measurements for determining risky blood sugar levels for the mother and her unborn baby.
“As result of this study, more than 16 percent of the entire population of pregnant women qualified as having gestational diabetes,” said lead author Boyd Metzger, MD. “Before, between 5 to 8 percent of pregnant women were diagnosed with this.”
Blood sugar levels that were once considered in the normal range are now seen as causing a sharp increase in the occurrence of overweight babies with high insulin levels, early deliveries, cesarean section deliveries and potentially life-threatening preeclampsia, a condition in which the mother has high blood pressure that affects her and the baby. Large babies, the result of fat accumulation, are defined as weighing in the upper 10 percent of babies in a particular ethnic group. Because large babies increase the risk of injury during vaginal delivery, many of the women in the study were more likely to have a cesarean section. To view entire news report written by science writer, Marla Paul click here.
Human Immunodeficiency Virus (HIV) damages the white blood cells of the immune system, reducing the body’s ability to fight off bacterial infection, viruses, and other diseases such as pneumonia and some cancers. Late stage HIV is often referred to as Acquired Immunodeficiency Syndrome (AIDS).
The most common causes of HIV infection are through sexual contact, infected blood transfusion, or sharing needles or syringes. HIV symptoms vary with the phase of infection. Early symptoms may resemble a flu virus, but infected individuals may show no symptoms for eight or nine years. Later symptoms include swollen lymph nodes, weight loss, fever, and diarrhea. Advanced HIV and AIDS symptoms are more severe and include night sweats, chills, fever, lesions or white spots in the mouth, headache and chronic diarrhea. Treatment for HIV involves an array of anti-retroviral medications, coordinated to each individual’s response. New treatments are continually being developed and tested in clinical trials.
Resources at Northwestern for HIV:
The HIV Center at Northwestern Memorial Hospital offers comprehensive assessment and treatment for HIV. The Center offers services such as patient/family education, medication instruction, clinical trials, medical and legal referrals and an infusion center. Within the HIV Center there are specialty clinics for patients needing care in medical areas of hepatology, neurology, ophthalmology and hematology, and also in obstetrics and gynecology. Inpatient hospital care is also provided with an interdisciplinary approach to disease treatment.
For more information contact: (312) 926-8358
Northwestern Physicians/ Researchers specializing in HIV treatment:
The Division of Infectious Disease at Northwestern’s Feinberg School of Medicine offers inpatient and outpatient services for the diagnosis and treatment of HIV and other infectious diseases. The Division’s 9 full-time faculty members all receive external grants for basic science and clinical research projects. Dr. Sarah Sutton’s research interests include perinatal transmission of HIV, and HIV and women, while Dr. Steven Wolinsky, the Division Chief, studies the evolutionary mechanisms at work in the emergence, spread and containment of diseases such as HIV.
Click to see physician profiles and clinic information:
IWHR Highlighted Researcher
Dr. Kimberly Scarsi, PharmD, MSc is a Research Assistant Professor in the Division of Infectious Disease at Northwestern University. Her research focuses on the pharmacokinetics of HIV treatment in women, particularly during pregnancy. Dr. Scarsi's research recognizes the need for studies in women since previous research has been conducted primarily in men. Dr. Scarsi is studying the fluctuation in antiviral concentrations during pregnancy, toward the goal of treating these women more efficiently. She is also comparing results of her studies in the US with sister studies in Africa, where nearly 60% of those infected with HIV are women. Recently Dr. Scarsi was chosen as a recipient of an Institute for Women's Health Research Pioneer Grant for the establishment of a long-term database of women in which she will be doing single-timed blood samples over the course of their pregnancy. She hopes to pinpoint the changes that occur in the second and third trimesters so that physicians may adjust dosages accordingly. Eventually the project may become a multicenter study in the US and internationally.
Useful Links and Resources:
The H1N1 flu, better known by its alias "swine flu," is still wreaking havoc around the world. Everyone is understandably concerned. Every time I am on the phone with my parents and let out something with the slightest resemblance to a cough, they command me to go see a doctor immediately and have the H1N1 test administered. The most recent report released by the Center for Disease Control and Prevention (CDC) stated that flu activity has begun increasing again. If you look at their actual data, however, it is a little comforting to see that the number of H1N1-positive tests has dropped in recent weeks as compared to a couple of months ago. The fact remains that about 20% of the 5,000+ tests conducted just this week came back positive for the flu - and about 65% of those were specifically categorized as H1N1 flu. Yikes.
Even more staggering are the statistics for pregnant women. Women naturally have weakened immune systems during pregnancy, but the H1N1 flu appears to hit even harder than usual. The CDC has stated that "6% of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant." (You can read a summary of this study by CDC officials published in The Lancet, one of the leading medical journals in the world.) History also tells us that with flu pandemics come increased numbers of spontaneous abortions and premature births. But have no fear! The H1N1 vaccine will be distributed very soon and pregnant women are atop the priority list. Even better, it has been reported that just one shot seems to be protective, so the current vaccine production could potentially immunize twice as many people.
It was also reported this week that the U.S. and a cohort of other nations are planning to donate a portion of their vaccine supplies for the World Health Organization (WHO) to administer in poorer countries around the world. There will undoubtedly be grumbling by some who do not want to share, but I applaud this decision. Why shouldn't expectant mothers in other lands receive the same protection as expectant mothers here in the U.S., to be given the best possible chance to have a healthy child, and to be alive to see them grow? I think we should be contributing as much as we can to the global control of this illness (and countless others!). What is your opinion on this issue?
For more information from the CDC: