Obstetrical providers' preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study.

OBJECTIVE: To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. DESIGN: Cross-sectional study. SETTING: Two public and two private hospitals in Argentina. POPULATION: Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. METHODS: Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. MAIN OUTCOME MEASURES: Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. RESULTS: 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. CONCLUSIONS: Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. TWEETABLE ABSTRACT: Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.

Awareness and attitude toward prenatal diagnosis of chromosomal abnormalities in patients with no access to legal termination of pregnancy.

OBJECTIVE: To analyze variables affecting couples' decision making about prenatal cytogenetic diagnosis in patients with no access to legal termination of pregnancy (TOP). METHODS: Patients undergoing invasive prenatal diagnosis were anonymously surveyed after counseling and before the procedure. The questionnaire enquired about sociodemographic features, medical history, knowledge of and attitudes toward genetic testing and TOP. RESULTS: Two genetic units distributed 372 questionnaires. Mean maternal age was 36 +/- 4 years. Access to prenatal genetic counseling was mainly patient's own initiative, or 'self-referral'. Most self-referred patients (87%) considered that 'receiving accurate information' was the main issue. Eighty-one per cent of all couples knew that TOP because of fetal anomalies was not legal. In case of a serious anomaly, 68.2% of patients would contemplate TOP, in spite of the risk of being exposed to an unsafe abortion. CONCLUSIONS: In many countries, prenatal genetic testing is offered, but TOP is not available. In the present study, although most of the couples who decided to undergo prenatal genetic testing were aware of this, they still chose to perform prenatal diagnosis. The main reason given was to obtain reliable information about fetal condition. Finally, if a fetal chromosomal abnormality were detected, most of them would consider TOP.

Blood glucose monitoring in gestational diabetes mellitus: 1- versus 2-h blood glucose determinations.

Gestational diabetes mellitus is a common disorder of pregnancy affecting 3-5% of pregnant women. Although significant controversy exists regarding its diagnosis and treatment, macrosomia has been consistently associated with maternal hyperglycemia. Numerous studies have addressed different approaches to monitoring blood glucose levels, but data on the ideal timing for postprandial determinations are scarce. This article reviews current recommendations and recent findings on the implications of 1- versus 2-h blood glucose determinations in pregnant women with gestational diabetes mellitus. Preliminary studies have shown a statistically significant reduction in macrosomia and decreased need for emergency Cesarean section among women monitored 1 h after meals. Until larger studies confirm these benefits, compliance is of the utmost importance for successful treatment. Therefore, patient preferences should be considered in planning a monitoring strategy.

Receptores de estrógeno y progesterona en músculos del piso pelviano / Strogen receptors and progesterone in muscles of the pelvic floor

El deterioro de la función de los músculos del piso de la pelvis se incrementa con la edad y se evidencia en las mujeres fundamentalmente durante la posmenopausia, siendo un factor etiopatogénico de gran importancia

Receptores de estrógeno y progesterona en músculos del piso pelviano / Strogen receptors and progesterone in muscles of the pelvic floor

El deterioro de la función de los músculos del piso de la pelvis se incrementa con la edad y se evidencia en las mujeres fundamentalmente durante la posmenopausia, siendo un factor etiopatogénico de gran importancia

Prevención primaria de defectos de desarrollo fetal en poblaciones de Latinoamérica: análisis de un modelo para modificar la estructura etaria materna / Primary prevention of fetal development defects in Latinamerica: analysis of a model to modify the maternal age distribution

Evaluar el impacto que, posibles acciones sobre la estructura etaria materna que tiendad a transferir la ocurrencia de embarazos en los extremos del ciclo reproductivo hacia edades maternas asociadas a un menor riesgo perinatal, representarian en la frecuencia de diversas anomalias del desarrollo(AU)

Prevención primaria de defectos de desarrollo fetal en poblaciones de Latinoamérica: análisis de un modelo para modificar la estructura etaria materna / Primary prevention of fetal development defects in Latinamerica: analysis of a model to modify the maternal age distribution

Evaluar el impacto que, posibles acciones sobre la estructura etaria materna que tiendad a transferir la ocurrencia de embarazos en los extremos del ciclo reproductivo hacia edades maternas asociadas a un menor riesgo perinatal, representarian en la frecuencia de diversas anomalias del desarrollo