Managerial Epidemiology: Case Study: Vaginal Birth after Cesarean (VBAC) A clien

Question

Managerial Epidemiology:

Case Study: Vaginal Birth after Cesarean (VBAC) A client had a cesarean delivery in a hospital setting for breech presentation with her first pregnancy. She is pregnant again and after exploring her delivery options, has decided she wants to attempt a vaginal birth after cesarean (VBAC). She has had an uncomplicated pregnancy this time and the fetus is not breech. The same OB-GYN will be assisting in her delivery. The OB-GYN performs a systematic review of the literature to assess the benefits and harms of VBAC versus repeat cesarean delivery. Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles.

Center of Disease & Prevention

National Institutes of health

1. What kinds and sources of data does the OB-GYN need to review in order to make a rational clinical planning decision?

2. Which types of studies available on this topic would be the most useful in clinical decision making? 3. What types of studies would you want to exclude?

4. Why would there be a lack of randomized clinical trials (RCT’s) available to address this clinical question?

Explanation / Answer

Ans 1) There is lot of careful steps and protocol an OB-GYN needs to follow and review before planning the rational clinical planning. The sources of data are the study of the report from her pregnancy. There are a lot of things that are involved when it comes to rational clinical planning of the child. It involves making consequential choice, understanding the information that is medically important, analysis all the risk and benefits and last seeking one’s choice. There are lot of risks when it comes to VBACs and it was also observed that there significant reduction in successful cases of delivery with such process.

Ans 2) There are many studies available which helps in making the right clinical decision where TOLAC is one of them. It helps in understanding the most probable outcome and the risks associated. The patients may experience rupture of urine on onset of labour and on attempting vaginal delivery after caesarean. It helps in understanding and identification of maternal characteristics along with medical history for better understanding. The occurrence of induction of labour many reduces the probability of vaginal delivery. Due to reduced success of VBAC, according to ACOG guidelines vaginal delivery is reduced.

There are some evidences based on which ACOG has made recommendations:-

There are studies that need to be made about maternal characteristics to find out if the woman is an ideal candidate for VBAC. Along with that obstetric history is also one important aspects to study.

There are many hormones which help in TOLAC. The oxytocin ripens the cervix and helps as natural pain reliever during child birth. It helps in shrinking uterus and reduces postpartum haemorrhaging. The rise in the level of Estrogen helps in preparing the uterus for labour and helps in preparing the mother for child birth.

Ans 3) The studies on the previous medical history can be avoided as all the tests will be freshly done. Anything that was detected from the previous caesarean pregnancy and delivery will not be majorly applicable in the recent studies. All the tests need to be freshly done along with TOLAC and position of the foetus.

Ans 4) There is lack of randomised clinical trial because the lack of volunteers due to the associated risks. A lot of woman and their family do not give consent to undergo the process of planned VBAC due to the risk to the baby. Randomised trial is not preferred and done since there might be risk to the mother like bleeding, requirement for blood transfusions, bladder damage etc.

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