Outcome after a high number (4-10) of repeated caesarean sections.

OBJECTIVE: To evaluate outcomes in caesarean sections repeated several times. POPULATION: Sixty-four women had had four or more (up to 10) caesarean sections. METHODS: The outcomes of these operations N= 149, study group) were compared with other caesarean sections. RESULTS: A quarter of the women in the study group complained of low abdominal pains during the late pregnancy. A thin or fenestrated isthmic myometrial layer was observed in 55% of their operations. Abnormal placentation with an increased risk of major operative complications occurred more often in the study group. No differences in post-operative complications or perinatal outcome emerged between the groups. CONCLUSION: Thus, no definitive upper limit for the number of caesarean sections per individual woman can be given.

Can the reproducibility of fetal heart rate baseline estimation be improved?

OBJECTIVE: To evaluate the reproducibility of fetal heart rate (FHR) baseline estimation according to an objective and detailed definition presented in this article, by comparison with the FIGO guidelines' definition. STUDY DESIGN: Three hundred consecutively acquired FHR tracings, 150 from antepartum high-risk pregnancies and 150 from unselected intrapartum cases, were presented to nine experienced clinicians included in three different groups, for an estimation of the FHR baseline. The first group consisted of clinicians using the proposed definition, without previous training in its use. The second group consisted of clinicians using the proposed definition, where a previous training session was promoted. The third group consisted of clinicians using the FIGO guidelines' definition. Agreement in baseline estimation was evaluated using the kappa statistic, the proportions of agreement and the intra-class correlation coefficient. RESULTS: Using the baseline definition proposed in this article, agreement was significantly higher in the group with prior training in its use. This group also showed a trend towards a higher agreement than the one using the FIGO guidelines. CONCLUSION: The FHR baseline definition proposed in this article provides an extremely reproducible estimation when associated with prior training in its use.