Wednesday, March 29, 2006

Update on NIH Elective Cesarean Conference

The National Institutes of Health has wrapped up its State of the Science Conference: Cesarean Delivery on Maternal Request. Video of day 1 and day 2 of the conference are available online; Day 3 is coming soon. A draft consensus statement on the topic (PDF) was issued today. The statement points out that rates of cesarean delivery have been increasing since the mid-1990's (reaching a record high of 29.1% in 2004), while rates of vaginal birth after cesarean (VBAC) have been falling since that time. The panel found that quality evidence was sparse for assessing differences in long-term and short-term outcomes between planned vaginal delivery (PVD) and cesarean delivery (CD), and so could not assess a number of outcomes, including hospital readmissions, adhesions, and chronic abdominal and pelvic pain syndrome. The panel did find moderate-quality evidence for two outcome measures, hemorrhage and maternal length of hospital stay. These indicated (according to the conference panel's assessment) that the frequency of postpartum hemorrhage was less for planned CD than for the combination of PVD and unplanned CD. They also found that maternal hospital stays were longer for CD than for vaginal delivery.

Overall, the conference results suggest that more quality vidence is needed with regards to outcomes in elective cesarean vs vaginal delivery. Other commentary/resources related to the conference:
  • Childbirth Connection offers a list of questions that need answers (PDF)
  • Lamaze International's press release on the topic, and white paper on elective cesarean vs vaginal birth (PDF)
  • American College of Nurse Midwives media briefing materials
  • WebMD's Healthy Pregnancy blogger responds to the idea, and gets a fair number of comments

    I hope to have time to watch the conference videos over the weekend, and may have additional commentary then.

    Technorati Tags: ; ;
    MeSH Tags: Cesarean Section/trends OR /utilization; Surgical Procedures, Elective

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