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- Page navigation anchor for Re: Impact of ACOG Guidelines on VBAC is UnderestimatedRe: Impact of ACOG Guidelines on VBAC is UnderestimatedShow More
Dr. Karel correctly identifies one of the limitations of using birth certificate data; unplanned VBAC deliveries are indistinguishable from planned VBAC deliveries. In our study this would underestimate the impact of the ACOG guideline revisions because unplanned deliveries would presumably remain similar over both time periods while considerably fewer planned VBAC deliveries occurred after the guideline changes. The fa...
Competing Interests: None declared. - Page navigation anchor for Impact of ACOG Guidelines on VBAC is UnderestimatedImpact of ACOG Guidelines on VBAC is UnderestimatedShow More
Zweifler et al in Vaginal Birth after Cesarean in California: Before and After a Change in Guidelines explored the impact of the 1999 ACOG guideline revision on vaginal birth after cesarean (VBAC) rates.(1,2) The authors attempt to measure the impact of the guideline revisions on the rate of VBAC in different populations by region, ethnicity, and education. If we want to demonstrate the true impact of these guidelines, o...
Competing Interests: None declared. - Page navigation anchor for Re: Could pregnancy complications confound the relationship between route of delivery and outcomes?Re: Could pregnancy complications confound the relationship between route of delivery and outcomes?Show More
Dr. Viswanathan points out the importance of accounting for pregnancy complications when evaluating studies of delivery outcomes. In fact, as we reported in our study, in a regression analysis including only newborns of normal and large birth weight, pregnancy complication was the only significant predictor of neonatal mortality.(1). However, suggesting that the major finding of our study was that the risk of neonatal morta...
Competing Interests: None declared. - Page navigation anchor for Could pregnancy complications confound the relationship between route of delivery and outcomes?Could pregnancy complications confound the relationship between route of delivery and outcomes?Show More
In their study of neonatal mortality, Zweifler et al. suggest that the risk of neonatal mortality is higher with attempted vaginal birth after cesarean (VBAC) than with repeat cesarean birth.(1) Their analysis covers a period (1996-2002) that includes changes in the American College of Obstetricians and Gynecologists (ACOG) guidelines to discourage VBAC in situations in which women lack access to emergency physicians. The...
Competing Interests: None declared.