OBJECTIVE: To determine the current practice patterns of Canadian obstetricians towards pregnant women at term, with intact membranes, who have had a previous Caesarean delivery. STUDY DESIGN: A questionnaire was developed in French and English, pretested, and mailed to all obstetricians registered with the Canadian Medical Directory. Two reminders were sent out at 3-week intervals. Respondents identities were kept anonymous. RESULTS: Of 1497 questionnaires sent out, 750 (50%) were returned. Of these 750 respondents, 102 were no longer working in obstetrics and 47 did not manage women with prior uterine incisions in labour, thus leaving 601 respondents (80% of all respondents) who did manage pregnant women in labour with previous Caesarean scars eligible for the analysis. Whereas 91% of these 601 respondents always counsel prospective vaginal birth after Caesarean (VBAC) candidates regarding the risk of uterine rupture, 9% never, or only occasionally, do so. Of these 601 respondents, 16% would use ultrasound assessment of lower uterine segment thickness to consider patients for VBAC, and 25% percent would use prostaglandins to induce labour in women who have had a previous Caesarean. CONCLUSION: There is considerable disparity in the approach of Canadian obstetricians to the management of women with a previous Caesarean delivery scar who come to term without the spontaneous onset of labour, including appropriateness of inducing labour. A large, multicentre, prospective, randomized controlled trial of large numbers of women would help to determine the safety of VBAC and induction of labour in the setting of a uterine scar.
OBJECTIVE: To determine the current practice patterns of Canadian obstetricians towards pregnant women at term, with intact membranes, who have had a previous Caesarean delivery. STUDY DESIGN: A questionnaire was developed in French and English, pretested, and mailed to all obstetricians registered with the Canadian Medical Directory. Two reminders were sent out at 3-week intervals. Respondents identities were kept anonymous. RESULTS: Of 1497 questionnaires sent out, 750 (50%) were returned. Of these 750 respondents, 102 were no longer working in obstetrics and 47 did not manage women with prior uterine incisions in labour, thus leaving 601 respondents (80% of all respondents) who did manage pregnant women in labour with previous Caesarean scars eligible for the analysis. Whereas 91% of these 601 respondents always counsel prospective vaginal birth after Caesarean (VBAC) candidates regarding the risk of uterine rupture, 9% never, or only occasionally, do so. Of these 601 respondents, 16% would use ultrasound assessment of lower uterine segment thickness to consider patients for VBAC, and 25% percent would use prostaglandins to induce labour in women who have had a previous Caesarean. CONCLUSION: There is considerable disparity in the approach of Canadian obstetricians to the management of women with a previous Caesarean delivery scar who come to term without the spontaneous onset of labour, including appropriateness of inducing labour. A large, multicentre, prospective, randomized controlled trial of large numbers of women would help to determine the safety of VBAC and induction of labour in the setting of a uterine scar.