Maternal car driving capacity after birth: a pilot prospective study randomizing postnatal women to early verses late driving in a driving simulator.

Background: Women are commonly advised to avoid driving following cesarean section (CS), however, this advice is based upon little evidence.Aims: We aimed to assess a woman's capacity to drive a car postbirth using a driving simulator to objectively examine driving behavior and competencies.Materials and methods: We conducted a pilot, prospective, randomized study from a tertiary referral hospital in Sydney, Australia. Postnatal women who were regular drivers and had given birth by vaginal delivery (VD), elective cesarean section (ElCS) or emergency cesarean section (EmCS) were randomized to early (2-3 weeks post birth) or late (5-6 weeks post birth) driver simulator testing. Driving performance was measured by reaction time to simulated impediments, awareness, attention, braking ability, traffic infringements, and accidents. Analysis was by intention to treat. Outcomes were assessed using contingency analysis via two-sample t-tests and Wilcoxen rank-sum tests.Results: 66 women were randomized and 38 attended simulator testing (57.6%; 19 early, 19 late; 8 VD, 14 ElCS, 16 EmCS). There was no difference in reaction times, driver awareness, braking times, or traffic infringements by early versus late testing (all p > .05), nor by mode of birth (p > .05) amongst the women who completed driver testing. At 7-8 weeks, all women were driving, without an accident.Conclusions: Although the study is limited by small sample size, there was no difference in driving capability by early versus late driving time since birth, nor by mode of birth. Further research is needed, but we cannot provide evidence to discourage well women from driving from 2-3 weeks post birth.

Cervical cerclage placed before 14 weeks gestation in women with one previous midtrimester loss: A population-based cohort study.

BACKGROUND: Cervical cerclage is used in an attempt to reduce recurrence risk of preterm birth, but evidence for use is limited. AIMS: To compare pregnancy outcomes among women with a single previous midtrimester delivery when managed with or without a cervical cerclage. MATERIALS AND METHODS: Population-based cohort study of all women in New South Wales, Australia with a singleton pregnancy ending in birth/miscarriage ≥14 and <28 weeks, between 2003 and 2011. Modified Poisson regression was used to compare outcomes in the next subsequent pregnancy, for women with a cerclage inserted <14 weeks, and those without cerclage. The primary outcome was gestational age <37 weeks at birth/miscarriage in the next pregnancy. Secondary outcomes included: maternal morbidity, preterm prelabour rupture of membranes (PPROM), stillbirth/neonatal death and composite neonatal morbidity for liveborn infants ≥28 weeks. Adjusted risk ratios (ARR) and 95% confidence intervals (CI) were determined. RESULTS: Five thousand, six hundred and ninety-eight births/miscarriages were potential index deliveries. Of these, 2175 women had an eligible subsequent pregnancy: 108 received cerclage at <14 weeks gestation, 2067 did not. Women with cerclage were significantly more likely to deliver <37 weeks than those without (39.8% vs 19.3%, ARR 1.92, 95% CI 1.48-2.48), and had increased risks of PPROM (ARR 4.38, 95% CI 2.62-7.32) and stillbirth/neonatal death (ARR 2.20, 95% CI 1.02-4.73). Following cerclage, liveborn infants ≥28 weeks had double the risk of severe morbidity (ARR 2.54, 95% CI 1.55-4.16). CONCLUSIONS: In women with a single previous midtrimester delivery, cervical cerclage <14 weeks gestation in subsequent pregnancy was associated with worse pregnancy outcomes.

Use of a hysteroscopic morcellator to resect miscarriage in a woman with recurrent Asherman's syndrome.

Uterine curettage may result in formation of intrauterine adhesions, which can predispose to recurrent miscarriage [1]. Herein is presented a video case report of a 24-year-old woman with recurrent miscarriages and recurrent intrauterine adhesions after treatment of non-progressive pregnancies. Targeted intrauterine pregnancy tissue removal using a hysteroscopic morcellator was performed to reduce the risk of adhesion recurrence. Successful removal of products of conception, without subsequent adhesion formation, and an ongoing viable pregnancy followed. Selective targeted removal of products of conception may offer some advantage to women with a predisposition to recurrent Asherman's syndrome.