Case #2 of 2: (50 pts) Cost/Benefit literature review for vaginal birth after ce

Question

Case #2 of 2: (50 pts) Cost/Benefit literature review for 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.

Part 1 of 2: Researching Empirical Evidence

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

The OB-GYN need to look into the historical data regarding the complications with respect to VBAC. The rate of succees and failure also needs to be analyzed on a broad database. The various aspects of critical health factors need to be considered and it can be obtained from the historical performance of VBAC operation.

The empirical studies that are available in the particular topic would be helpful since it is a practical decision and theoretical knowledge alone won't be enough to give a clear recommendation regarding the operation.

The studies which are theory based without any clear empirical evidence or do not have enough database to justify its stand would lead to failed attempt at understanding the case from a historical perspective.

The lack of randomized clinical trials may be attributed to the fact that the VBAC case is a special one and it is not applied to everyone. Only in cases where the patient gives full consent then only VBAC is used as a methodology.

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