جستجوی مقالات مرتبط با کلیدواژه « زایمان واژینال پس از سزارین » در نشریات گروه « پزشکی »

The high prevalence of cesarean section in most developed countries, exceeding 50%, has led to detrimental effects on maternal and child health. Vaginal birth after cesarean (VBAC) is a beneficial way to reduce cesarean rates. This study aimed to determine the effect of theory of planned behavior-based training on the intention and behavior of VBAC in pregnant women with previous cesarean section.

Methods & Materials: 

In this randomized controlled trial study, a convenience sample of 70 pregnant women with a history of cesarean section, referred to comprehensive health centers in Ardabil in 2020, were randomly assigned to either the intervention or control group. The intervention group received four weekly education sessions based on the theory of planned behavior structures, while the control group received standard care. Data were collected using a researcher-developed questionnaire at three time points: before, immediately after, and four weeks after the intervention. Data analysis was conducted using SPSS software version 16, employing independent t-test, Fisher’s exact test, chi-square test, and repeated measures ANOVA at a 95% confidence level.

Repeated measures ANOVA revealed significant differences in mean scores of attitude, subjective norm, perceived behavior control, intention, and awareness over time between the intervention and control groups (P<0.001). However, the educational intervention did not lead to a behavior change.

Based on the findings, it is imperative for health planners to focus on providing organizational support and fostering a positive attitude among obstetricians and midwives to prioritize the implementation of VBAC.

Vaginal birth is considered a safe mode of birth for most women who have had a prior caesarean with a transverse incision. However, most women who had a previous caesarean rarely choose vaginal delivery. The present study was performed with aim to explain the beliefs of women with a history of previous cesarean section regarding vaginal birth after cesarean in order to provide some suggestions for future interventions to increase vaginal delivery.

This qualitative study framed by the Theory of Planned Behavior was conducted in the governmental hospitals of Urmia, Iran in March-February 2017. Data were collected using 24  in-depth semi-structured individual interviews.  Participants were selected among  pregnant and postpartum women with a history of cesarean section through purposeful sampling, until data saturation was reached. Data were analyzed through directed content analysis approach using the MAXqda software (version 10).

The findings were grouped into three themes namely: "attitude towards vaginal birth after cesarean" (Vaginal birth as a fast and cost-effective method of delivery, sense of danger about maternal-fetal harm), "normative beliefs towards vaginal birth after cesarean" (the emphasize of important people towards vaginal birth after cesarean, women's impression of vaginal birth after cesarean in the community) and "control beliefs towards vaginal birth after cesarean" (Individual and social barriers and facilitator).

Women's attitudes, subjective norms, and control beliefs influence choosing vaginal childbirth after cesarean section. Education based on the theory of planned behavior could be considered with the aim of promoting vaginal delivery after cesarean section.

Although vaginal birth after cesarean is a more appropriate alternative comparing to repeat cesarean for eligible individuals, making decision between these two choices is a challenging process and depends on the decision of care providers and mothers. The studies about shared decision making showed different results about mode of birth after cesarean; therefore, this study was performed with aim to review shared decision making about knowledge, decisional conflict and choosing mode of delivery after cesarean.

In this study, for access to the related articles, search was done on PubMed, Scopus, up to date, google scholar, Cochrane and web of science using the MESH-related keywords including "Vaginal birth after cesarean", "Shared decision making", "decision Aid" and "Counseling", as well as Persian databases off SID, magiran and IranMed from October 2018 to July 2019. The quality of the articles was assessed using the Consort Checklist 2017.

From the total of 120 articles found in the databases, 4 articles entered the study according to inclusion criteria. In various studies, Shared decision making methods had a contradictory effect on choosing vaginal birth after cesarean, but had a significant effect on knowledge and decisional conflict.

The use of Shared decision making methods increases the knowledge of women with previous cesarean about choosing the mode of delivery and decreases the decisional conflict. Since the results about choosing birth after cesarean are inconsistent, further studies are needed.

The measurement of the lower uterine segment (LUS) thickness before labor predicts hazardous complications of vaginal birth after cesarean section (VBAC). Vaginal birth after cesarean is one of the most effective methods used to reduce the incidence of cesarean section. Therefore, this study was carried out to evaluate the diagnostic value of sonographic measurement of lower uterine segment (LUS) thickness in uterine rupture during cesarean section and its associated factors in women with and without previous cesarean section.
This prospective cohort study was conducted among 168 pregnant women in two groups of with and without the history of cesarean section (84 individuals per group) referred to Ardabil Alavi Hospital, Ardabil, Iran, in 2016. The thickness of the LUS was determined through transabdominal ultrasonography between the gestational ages of 36 to 40 weeks. At the time of cesarean section, the thickness of the women’s LUS and newborns’ weight and Apgar score were measured and recorded. Additionally, uterine rupture was recorded in patients with the past history of cesarean section. Moreover, the relationship between the LUS thickness and maternal age, gestational age, the indication for previous cesarean section, interdelivery interval, embryo weight, and abnormalities of erythrocyte were determined. Data analysis was performed using descriptive statistics and t-test in SPSS software, version 16.
According to the pre-operative assessments, the LUS thickness in the women with and without the history of cesarean section were 4.26±1.99 mm and 6.11±1.6 mm, respectively (P˂0.001). According to the findings obtained from sonography before and during the operation, there was a significant difference between the groups in terms of LUS thickness (P0.05). Based on the results, the LUS thickness of 1.8 mm was considered as the critical cutoff value for predicting uterine rupture.
The measurement ofLUS thickness is a non-invasive technique to predict the uterine rupture, which leads to increased rate of VBAC.

Vaginal delivery is the best method of delivery. Regarding to recent data (1382) 33% of deliveries were carried out using cesarean method in Iran. Increasing of cesarean percentage is probably due to negative attitude about vaginal delivery and low knowledge about cesarean side effects. This research is aimed to determine knowledge and attitude of pregnant women about type of delivery. This descriptive study was conducted on 136 pregnant women attended to eight health centers in Qom during Jun to August of 2003. The tool for data collection was questionnaire including, demographic obstetrical and gynecological factors and some questions about knowledge and attitude about vaginal and cesarean delivery. The questionnaire was provided by counseling with experts in midwifery and gynecology and its reliability was confirmed by test and retest. Data were analyzed using descriptive statistics, ², Man Whitney and Kruskal Wallis. The levels of knowledge in the pregnant women about type of delivery, in 40.4% were average and in 59.6% were good. In this study 94.1% of women toward vaginal delivery and 63.2% toward cesarean delivery had positive atitudes, 5.9% of subjects toward vaginal delivery and 36% toward cesarean had indifferent attitude. Significant statistical difference was observed between the level of knowledge and attitude of cesarean delivery (P< 0.0001), but no significant statistical difference was observed between the level of knowledge and attitude of vaginal delivery

Increasing of caesarean delivery beyond of acceptable rate, can have negative effects on the health of the mother and baby and economy of the society. Because of one-third of total caesarean deliveries are due to repeated caesarean, promotion of vaginal birth after caesarean can be a valuable way for decreasing of caesarean rate. The purpose of this study was to determine the attitude of gynecologists and midwives about vaginal birth after caesarean and barriers about it. This descriptive study was done on 124 gynecologists, residents and midwives. Gynecologists, residents and midwives of maternity units were selected by random sampling method from teaching hospitals and midwives of health centers were selected by cluster sampling. Research instrument was two sections questionnaire consist of: demographic characteristic and attitude assessment form include 21 phrases with minimum score of 0 and maximum 42. According acquired score attitude was classified to three levels: agree, neutral and disagree. Data were analyzed by using chi- square test, t test, and analysis of variance and Pearson correlation. Data analysis indicated that most of gynecologists (80%), residents (61.1%), midwives in maternity units (81.4%) and midwives in health centers (60.5%) had positive attitude about vaginal birth after caesarean. There was a significant difference between attitude of subjects base on job (P=0.027) and time of graduation (P=0.049). According the views of gynecologists, no legal supports were the most barriers about VBAC. By attention to positive attitude of the gynecologists and midwives, for promotion of vaginal birth after caesarean, searching of barriers and solving them is suggested.