Despite the consequences for women’s health, a repeat cesarean section (CS) birth after a previous CS is common in Western countries. Vaginal Birth After Cesarean (VBAC) is recommended for most women, yet VBAC rates are decreasing and vary across maternity organizations and countries. We investigated women’s views on factors of importance for improving the rate of VBAC in countries where VBAC rates are high. We interviewed 22 women who had experienced VBAC in Finland, the Netherlands, and Sweden. We used content analysis, which revealed five categories: receiving information from supportive clinicians, receiving professional support from a calm and confident midwife/obstetrician during childbirth, knowing the advantages of VBAC, letting go of the previous childbirth in preparation for the new birth, and viewing VBAC as the first alternative for all involved when no complications are present. These findings reflect not only women’s needs but also sociocultural factors influencing their views on VBAC.
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Background The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC. Methods The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, ‘Effective Public Health Practice Project’. The primary outcome measure was VBAC rates. Results 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates. Conclusions This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.
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Detection and identification of body fluids are crucial aspects of forensic investigations, aiding in crime scene reconstructions and providing important leads. Although many methods have been developed for these purposes, no method is currently in use in the forensic field that allows rapid, non-contact detection and identification of vaginal fluids directly at the crime scene. The development of such technique is mainly challenged by the complex chemistry of the constituents, which can differ between donors and exhibits changes based on woman’s menstrual cycle. The use of fluorescence spectroscopy has shown promise in this area for other biological fluids. Therefore, the aim of this study was to identify specific fluorescent signatures of vaginal fluid with fluorescence spectroscopy to allow on-site identification. Additionally, the fluorescent properties were monitored over time to gain insight in the temporal changes of the fluorescent spectra of vaginal fluid. The samples were excited at wavelengths ranging from 200 to 600 nm and the induced fluorescence emission was measured from 220 to 700 nm. Excitation and emission maps (EEMs) were constructed for eight donors at seven time points after donation. Four distinctive fluorescence peaks could be identified in the EEMs, indicating the presence of proteins, fluorescent oxidation products (FOX), and an unidentified component as the dominant contributors to the fluorescence. To further asses the fluorescence characteristics of vaginal fluid, the fluorescent signatures of protein and FOX were used to monitor protein and lipid oxidation reactions over time. The results of this study provide insights into the intrinsic fluorescent properties of vaginal fluid over time which could be used for the development of a detection and identification method for vaginal fluids. Furthermore, the observed changes in fluorescence signatures over time could be utilized to establish an accurate ageing model.
DOCUMENT
Een op de vier vrouwen heeft last van vaginale verzakking. Dit ontstaat doordat de bekkenbodemspieren uitrekken of beschadigd raken, vaak na een zwangerschap en een (vaginale) bevalling. Bij het ouder worden leidt een verzakking vaak tot klachten zoals pijn en incontinentie. Opereren wordt het liefst vermeden wegens complicatierisico’s, het gebruik van een pessarium is een goed alternatief. Een pessarium is een ring of kapje die in de vagina wordt gebracht en ervoor zorgt dat blaas en baarmoeder weer op hun normale plaats komen te liggen. Klachten kunnen zo verminderen of verdwijnen. Voorwaarde is dat het pessarium de goede maat heeft en op de juiste plaats zit en dat is dan ook gelijk de uitdaging: het aanmeten van een geschikt pessarium is trial-en-error en niet prettig. Bovendien kan na het plaatsen van een pessarium irritatie aan de vaginawand ontstaan. Elke 3-6 maanden moet het pessarium worden schoongemaakt, waarvoor met name oudere patiënten teruggaan naar de huisarts of gynaecologe. Om de zelfredzaamheid van deze vrouwen te verhogen is een pessarium dat 1) men zelf makkelijk in- en uit kan doen en goed schoon te maken is, en 2) eenvoudig op de juiste maat te verkrijgen en aan te meten is, dan ook zeer wenselijk. Er zijn mogelijkheden met 3D scannen en 3D printen. In dit project wordt door Saxion lectoraten Industrial Design en Technology, Health & Care, FabLab Enschede, Gynaecologen Coöperatie Oost Nederland (Gycon) en ziekenhuis ZGT een verbeterd pessarium ontwikkeld. Lectoraat Industrial Design en FabLab Enschede brengen kennis op het gebied van gebruiksonderzoek en 3D printen/scannen. Lectoraat Technology, Health & Care brengt kennis over adoptie van nieuwe technologieën in de zorg. Gycon levert medische kennis en samenwerking met cliënten Voor ZGT is dit een manier om ervaring op te doen met 3D printen in samenwerking met ziekenhuis MST 3D-printlab.
