The History of the Low Transverse Cesarean Section: The Pivotal Role of Munro Kerr.

BACKGROUND: Cesarean section has undergone a transformation that has radically changed the prognosis of both the pregnant woman and her unborn child. The attributed mortality rate of Cesarean section during the 19th century was over 50% worldwide. Today, mortality from Cesarean delivery is rare. However, the technique of transversely incising the uterus in its lower uterine segment, although less than a century old, is passed on from instructor to apprentice, often without either of them being aware of its noble history. In this brief review, we discuss the reported history regarding this incision and the significant role played by John Munro Kerr.

A case-control study of caesarean delivery on maternal request: who and why?

OBJECTIVE: The current study aimed to evaluate the profile of women who are most likely to undergo caesarean delivery on maternal request (CDMR) and clarify their reasons for this decision. METHODS: For this multicentre case-control study, data were collected from 429 women who underwent CDMR and 429 matched controls who delivered vaginally from June, 2008 through February, 2009. Participants were interviewed by telephone regarding sociodemographic variables, health and lifestyle. RESULTS: CDMR predictors were as follows: increasing age (OR = 1.09/year; 95%CI: 1.05-1.14), family status (unmarried without a steady partner versus married - OR = 3.60; 95%CI: 1.08-11.97), decreasing level of religiosity (secular versus ultra-orthodox - OR = 11.82; 95%CI: 3.75-37.21), and never having engaged, or ceasing sports activity during pregnancy (OR = 1.79; 95%CI: 1.09-2.91 and 2.38; 95%CI: 1.28-4.43, respectively). Above average income reduced the probability of CDMR (OR = 0.56; 95%CI: 0.33-0.94). The most frequent reasons for choosing CDMR were concern for pain (21.9%), concern for their own or baby's health (20.4% and 16.5%, respectively) and emotional aspects (10.0%). CONCLUSIONS: Older, unmarried and/or secular women had increased probability of CDMR. Addressing specific concerns regarding vaginal delivery may provide the basis for a patient-oriented intervention for preventing unnecessary surgery.

[QUALITY MEASURES IN MEDICINE-- A PLEA FOR NEW, VALUE BASED THINKING].

Quality is an important and basic conduct of complex systems in general and health systems in particular. Quality is a cornerstone of medicine, necessary in the eyes of the community of consumers, caregivers, and the systems that manage both. In Israel, the Ministry of Health has set the quality issue on the agenda of healthcare organizations in all existing frameworks. In this article we seek to offer an acceptable alternative perspective, in examining the quality of public health. We suggest highlighting the ethical aspect of medical care, while reducing the quantitative monitoring component of existing quality metrics. Relying solely on indices has negative effects that might cause damage. The proposed alternative focuses on the personal responsibility of health care providers, using. values and moral reasonin.

Pregnancy Prevention and Termination of Pregnancy in Adolescence: Facts, Ethics, Law and Politics.

We present an overview of the current sexual behavior of adolescents in Israel, including the related social and moral issues, and compare it to that in Western countries. An important factor is the existence of liberal versus conservative views regarding the use of contraception and termination of pregnancy in these young subjects. We describe the current situation where in most cases the medical providers do not provide adequate contraceptive advice to adolescent girls, resulting ultimately in a high rate of unintended pregnancy. In our opinion, it is essential to make effective contraception more accessible to this vulnerable group.

[The social and medicolegal aspects of maternal request or non-medically indicated cesarean section].

Patient choice cesarean or cesarean by maternal request/ demand is a controversial issue. The medical literature contains evidence based data on the medical aspects of patient choice cesarean, risks and benefits to the mother and her newborn. Fewer studies focused on the social and legal aspects of patient choice cesarean. This opinion paper discusses the social and legal aspects of patient choice cesarean.

Cost-utility analysis of vaccination against HPV in Israel.

Using WHO-CHOICE methodology, we calculated cost-utility ratios for various interventions (PAP smear, HPV-DNA testing, VIA and vaccination against HPV) at various frequencies to reduce the burden of cervical cancer and condyloma (in the case of the HPV vaccination) in Israel, which has a low prevalence of cervical cancer. Assuming non-waning efficacy, HPV vaccinations will become cost-effective, very cost-effective and cost saving when the cost per dose falls below $96.85, $50.42 and $27.20, respectively. Attempts should be made to raise compliancy with PAP smears from the current opportunistic 12.2-20.0% per annum either before and/or after the vaccination is introduced.

[Trauma in pregnancy].

Trauma is the leading non-obstetric cause of maternal death. Whereas maternal mortality and morbidity due to obstetrical reasons are decreasing, those related to trauma, mainly motor vehicle accidents, are increasing. Knowledge and awareness of normal physiological changes during pregnancy and the unique response to stress and trauma, is essential for all caregivers treating trauma patients. Key points for appropriate changes in various systems and their relevant application for diagnosis, treatment and resuscitation approaches are presented. Peri-mortem cesarean section, although rarely required, is discussed. Preventive measures in pregnancy, especially the use of seat belts, are emphasized.

Domestic abuse in pregnancy: results from a phone survey in northern Israel.

BACKGROUND: Domestic violence is considered a major risk factor in pregnancy. OBJECTIVES: To assess the prevalence of different kinds of abuse (physical, psychological, sexual) of pregnant as compared to non-pregnant women, and to identify demographic risk factors for physical abuse that characterize the woman and her partner. METHODS: A cross-sectional survey was conducted in 270 women seeking gynecologic care at women health centers in northern Israel. Information was collected by means of a standardized questionnaire administered via phone, and addressing demographic data, interaction with the partner, and reporting of physical abuse. All information was obtained from the respondents (including information about her partner). RESULTS: Four abuse scores were computed: severe physical attack, minor physical attack, psychological abuse, and sexual coercion. Psychological abuse was found to be the most prevalent (24%), followed by minor and severe physical attack (17% and 8.1%, respectively), and sexual coercion (5.6%). Physical attacks related to pregnancy (directed at the abdomen) occurred in 5.4% of the pregnant women. There was no significant difference in the prevalence of the different types of abuse between pregnant and non-pregnant women. Physical attack was associated with socioeconomic status, work status, and degree of religiosity. CONCLUSION: Pregnant women were at a similar risk for abuse as non-pregnant women in all abuse categories. Predictors for abuse--socioeconomic status and religiosity--were reviewed primarily in a cultural context.