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VBAC: Friend or Foe

Outline. HistoryA public health perspectiveIndicationsIndividualizationConclusions. Cesarean delivery : History. A cross-cultural phenomenonJulius CesarLex CaesareaCaedere secoUsually a postmortem procedure. Cesarean delivery : History. Jacob Nufer (1500) first reported survivorBennet (1794

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VBAC: Friend or Foe

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    1. VBAC: Friend or Foe Raphi Pollack, MDCM, FRCSC., Bikur Cholim Hospital, Jerusalem, Israel.

    2. Outline History A public health perspective Indications Individualization Conclusions

    3. Cesarean delivery : History A cross-cultural phenomenon Julius Cesar Lex Caesarea Caedere seco Usually a postmortem procedure

    4. Cesarean delivery : History Jacob Nufer (1500) first reported survivor Bennet (1794) USA Radford (1880) 131 Cesareans with mortality of 83%

    5. Cesarean Delivery: Development Historically a post-mortem procedure. Breakthroughs: Anesthesia Aseptic technique (Lister 1870) Sutures (Sanger 1880) Low transverse incision (Kerr 1926)

    6. Low transverse incision Kerr 1926 Replaced the Classical incision Decreased maternal mortality Decreased hemorrhage Decrease peritonitis

    7. Conservatism in Obstetrics “No matter how carefully the uterine incision is sutured, we can never be certain that the cicatrized uterine wall will stand a subsequent pregnancy and labor without rupture. This means that the usual rule is once a cesarean, always a cesarean” Edwin Craigin, 1916

    8. CRAIGIN WAS RIGHT !! He was referring ONLY to classical cesarean scars

    9. Mode of delivery vs. Risks LTCS Mortality Hemorrhage Oper. Trauma Infection VTE Accreta/ rupture Bonding SVD VTE Pelvic floor injuries Episiotomy complications Sphincter injuries

    10. Placenta Previa & Placenta accreta

    11. Cesarean Delivery: The Epidemic

    12. Cesarean Rates : Brazil

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