Study of success rate of vaginal birth after cesarean section in relation to FLAMM score

Background: Globally, there is an increased trend of cesarean section (CS). Repeat CS is associated with various complications. Successful vaginal birth after caesarean section (VBAC) helps to decrease CS rate and its associated morbidities. Practice of protocol of applying FLAMM score and monitoring by partogram reduces the rate of cesarean section in the previous one lower segment cesarean section patient. Aims and Objectives: The present study is conducted to evaluate the impact of FLAMM scoring for vaginal birth after CS on obstetrics and perinatal outcome in case of the previous one lower segment CS delivery. Materials and Methods: The prospective and observational study was conducted in Obstetrics and Gynaecology department of one of the teaching institutes of Ahmedabad over a period of 1 year. Total 100 pregnant women from labour room with history of the previous one CS, who gave consent for trial of labor after the previous cesarean (TOLAC) were selected and FLAMM score applied on them. Study participants were divided in two groups according to outcome. Group A: Successful TOLAC and Group B: Failed TOLAC. Maternal and neonatal outcome was measured in both groups. Results: Out of 98 patients <40 years, 74.48% had VBAC and 25% had failed TOLAC and two patients were >40 years of age had VBAC. Out of 94 patients with favorable FLAMM’s score, 79% (n = 75) had VBAC and 100% (n = 6) with unfavorable FLAMM had CS. Conclusion: Careful patient selection for TOLAC is of utmost priority to increase success rate and decrease complications. FLAMM scoring system is a very efficient guiding tool for this. By applying FLAMM score, we increase success rate of TOLAC and thereby decrease CS rate in case of previous CS.

Non-pathology: the bedrock of pathology.

Pathology, also called morbid anatomy, is macroscopically, microscopically, and molecularly so manifest an array of phenomena that it has compelled medical men to closely link it up with disease, dis-ease, and death. But there is more than meets the eye of the morbid anatomists, microscopists, and the molecular biologists. The obvious science of pathology is governed by numerous abstract, subtle, non-pathological factors. A pathological phenomenon is subservient to cosmic noumenon. Such a sea-change allows a newer perspective that cures modern medicine of many of its dogmas and provides epistemologically valid directions to research methodologies on the one hand and clinical practices on the other.

Cause of death--so-called designed event acclimaxing timed happenings.

Cause-of-death as an established global medical institution faces its greatest challenge in the commonplace observation that the healthy do not necessarily survive and the diseased do not necessarily die. A logical analysis of the assumed relationships between disease and death provides some insights that allow questioning the taken-for-granted relationship between defined disease/s and the final common parameter of death. Causalism as a paradigm has taken leave of all advanced sciences. In medicine, it is lingering on for anthropocentric reasons. Natural death does not come to pass because of some (replaceable) missing element, but because the evolution of the individual from womb to tomb has arrived at its final destination. To accept death as a physiologic event is to advance thanatology and to disburden medical colleges and hospitals of a lot of avoidable thinking and doing.

Qualtum cosmics-and-chaotics--the ultimate tortoise in physics and modern medicine.

Qualtum cosmics is the qualitative opposite of quantum mechanics. The flip-side of qualtum cosmics is qualtum chaotics, the two governing much of what is seen as inscrutable in medicine. The Ultimate (Last) Tortoise is close to Einsteinean idea of a Unified Theory, a single concept that can explain whatsoever there is in physics, (and in medicine, or what have you).

An epitaph for the gene. An obituary for genetics. An adieu for heredity.

Modern medicine has been researching on cancer cell, cancer, hypertension, heart attack and so on without once defining any of these clearly. It swears by these terms much like mankind swears by sunset and sunrise, which are just not there. It is possible that the pet hobbyhorses of modern times, namely, gene, genetics, and heredity may belong to the above mythical group-entities that are logically absent, but whose illogic is strong enough to sustain research and publication world over. Gene, genetics and heredity have outlived their utility and must be replaced in near future by new concepts and terms.

TRAS principles blight arterial bypass and plasty.

A new concept--Tissue Requisitions (Principle I)/Relinquishes (Principle II) Arterial Supply--of TRAS principles is introduced to help appreciate the failures/successes of modern medicine's attempts at restoring arterial flow in luminally compromised coronary/carotid fields, an invasive branch rightly called vascular ReRheology, which comprises diagnosing/treating arterial blocks. The technical wizardry of arterial reconstruction (bypass) or lumen--restoration (plasty) has to reckon with the TRAS principles all the time.

Reaction of peripheral nerves to vascular and bacterial injuries.

Mouse sciatic nerves were subjected to devascularization, M. leprae inoculation, and combined insult of devascularization + footpad inoculation (FPI). Changes were seen in FPI nerves only after eight months, but in cases of combined insult, changes were evident in hours. Both the groups showed initial loss of small myelinated fibres. No proliferation of Schwann cells was in FPI nerves, but in combined insult it was maximum after two weeks. Presence of M. leprae seems to be arresting Schwann cell activity after two weeks. Blood vessels showed increased endothelial cell cytoplasm, basement membrane proliferation and villi formation. These changes seem to be specific of endoneurial blood vessels of leprosy nerves. Increased number of mast cells seems to be specific of devascularized and FPI nerves. Increased number of macrophages expressed low immunity of devascularized nerves. Eosinophils migrated to endoneurium as a result of leakage of axoplasm.