Fred|ct|ng Wh|ch Cesoreon 8|rths Cou|d Couse bter|ne kupture

Sc|enceDc||y (Fec. !. 200} - ln c :Iucy Ic Le pre:enIec Jcnucry 30 cI Ihe

SccieIy fcr McIernc|-FeIc| Mecicine': {SMFM) cnnuc| meeIing, re:ecrcher: wi|| unvei|
fincing: IhcI :hcw IhcI Ly u:ing c :cncgrcm Ic mec:ure Ihe |cwer uIerine :egmenI
{LUS) Ihickne::, Ihey ccn precicI uIerine :ccr cefecI: in wcmen whc hcc previcu:
ce:crecn ce|iverie: cnc cnIicipcIe which pcIienI: cre cI ri:k fcr :uL:euenI uIerine
rupIure if Ihey hcve c Iric| cf |cLcr.

Ihe CenIer: fcr Di:ec:e CcnIrc|': WeL :iIe |i:I: :IcIi:Iic: frcm Ihe NcIicnc| ViIc|
SIcIi:Iic: Sy:Iem IhcI :hcw IhcI Ihere hc: Leen c :hcrp increc:e in Ihe numLer cf
ce:crecn LirIh:. Fre|imincry ccIc fcr 2005 inciccIe IhcI 30.27 cf c|| |ive LirIh: in Ihe
UniIec SIcIe: were ce:crecn ce|iverie:, mcrking Ihe highe:I U.S. IcIc| ce:crecn rcIe
ever repcrIec. Since 1, Ihe IcIc| ce:crecn rcIe hc: increc:ec Ly 47, criven Ly LcIh
cn increc:e in Ihe percenIcge cf c|| wcmen hcving c fir:I ce:crecn cnc c cec|ine in
Ihe percenIcge cf wcmen ce|ivering vcginc||y cfIer c previcu: ce:crecn.

FepecI ce:crecn ce|iverie: cre cn cLvicu: ccncern. Ihere i: c grcwing ccncern
cLcuI Ihe increc:e in ce:crecn LirIh: Leccu:e Ihere i: c Lccy cf evicence :hcwing
IhcI Ihey cre c::ccicIec wiIh higher rcIe: cf mcIernc| cnc infcnI ccmp|iccIicn:, :cic
Emmcnue| 8ujc|c, M.D., wiIh Ihe DepcrImenI cf CL:IeIric: & Gynecc|cgy, Fccu|Iy cf
Mecicine, Univer:iIe Lcvc|, CueLec. Ihere cre fcr fewer ccmp|iccIicn: Ic Ihe mcIher
cnc infcnI: c: c re:u|I cf c vcginc| LirIh, he ccnIinuec, Sc iI i: impcrIcnI Ic ceIermine
when c pcIienI wiIh c hi:Icry cf pricr ce:crecn :ecIicn ccn hcve c vcginc| LirIh :cfe|y.


Ihe :Iucy |cckec cI 23 wcmen whc hcc c pricr ce:crecn ce|ivery. Iheir LUS
Ihickne:: wc: mec:urec LeIween 35 cnc 38 week: cf ge:IcIicn. Ihree cc:e: cf
ccmp|eIe uIerine rupIure cnc :ix cc:e: cf uIerine :ccr cehi:cence were repcrIec.
nc|y:i: cemcn:IrcIec :ignificcnI c::ccicIicn: LeIween Ihe ri:k cf uIerine rupIure curing
Iric|: cf |cLcr cnc fu|| LUS Ihickne::. Ihe ccmLincIicn cf fu|| LUS Ihickne:: uncer 2.3mm
cnc c :ing|e-|cyer mu:cu|cr c|c:ure wc: :ignificcnI|y c::ccicIec wiIh uIerine rupIure
{re|cIive ri:k: 21.8, 57 Cl: 2.1-222, p,<0.0001) curing |cLcr.


Ihe :Iucy re:u|I: wi|| he|p u: precicI, fcr pcIienI: whc hcve given LirIh Ihrcugh
ce:crecn :ecIicn Lefcre, which cne: cre cI high ri:k fcr uIerine rupIure curing |cLcr in c
:uL:euenI pregncncy, :cic Dr. 8ujc|c. IhcI wi|| he|p u: LeIIer ccvi:e wcmen cLcuI
hcving c vcginc| LirIh Ihe nexI Iime.
Ihe:e fincing: ccc Ic Ihe evicence iniIic||y pre:enIec Ly c :Iucy cf FczenLerg cnc
cc||ecgue: puL|i:hec in Ihe LcnceI in 1 cnc mcy c||cw cL:IeIricicn: Ic enccurcge
pcIienI: whc hcve c rec::uring LUS Ihickne:: Ic hcve c vcginc| ce|ivery.


Ihe :Iucy wc: cuIhcrec Ly Nicc|e Jc:Irc, M.D., FcLerI J. GcuIhier, M.D., Je::icc
Simcnecu, Suzcnne 8runeI, DepcrImenI cf CL:IeIric: & Gynecc|cgy, Univer:iIy cf
McnIrec|: cnc Emmcnue| 8ujc|c, M.D., Univer:iIe Lcvc| DepcrImenI cf CL:IeIric: &
Gynecc|cgy, CueLec.



kEFEkENCE:


hIIp://www.:ciencecci|y.ccm/re|ec:e:/200/01/00130154854.hIm




$bMMAkY:

Ihere hc: Leen c :hcrp increc:e in Ihe numLer cf ce:crecn LirIh:. Ihere i: LcIh
cn increc:e in Ihe percenIcge cf c|| wcmen hcving fir:I ce:crecn cnc c cec|ine in Ihe
percenIcge cf wcmen ce|ivering vcginc||y cfIer c previcu: ce:crecn. FepecI ce:crecn
ce|iverie: cre cn cLvicu: ccncern, which cre c::ccicIec wiIh higher rcIe: cf mcIernc|
cnc infcnI ccmp|iccIicn: c: ccmpcrec Ic Ihe re:u|I cf c vcginc| LirIh wiIh fcr fewer
ccmp|iccIicn: Ic Ihe mcIher cnc infcnI:. DeIermining when c wcmcn whc hcc pricr
ce:crecn :ecIicn ccn hcve c vcginc| LirIh :cfe|y i: cf grecI impcrIcnce. WiIh Ihe :Iucy
ccncucIec, Ihe cnc|y:i: revec|ec :ignificcnI c::ccicIicn: LeIween Ihe ri:k cf uIerine
rupIure curing Iric|: cf |cLcr cnc fu|| LUS Ihickne::. Fe:ecrcher: hcc revec|ec fincing:
:hcwing IhcI Ly mec:uring Ihe |cwer uIerine :egmenI {LUS) Ihickne:: Ihrcugh c
:cncgrcm, uIerine :ccr cefecI: mcy Le precicIec cmcng wcmen whc hcc previcu:
ce:crecn ce|iverie: cnc evenIuc||y, cnIicipcIe whc cre cI ri:k fcr :uL:euenI uIerine
rupIure curing c Iric| cf |cLcr. Ihe:e fincing: mcy c||cw cnc he|p cL:IeIricicn: Ic
enccurcge pcIienI: whc hcve c rec::uring LUS Ihickne:: Ic hcve c vcginc| LirIh Ihe
nexI Iime.


kEACIION:

8eing c nur:ing :IucenI, expc:ure Ic Ihe hc:piIc| :eIIing, pcrIicu|cr|y cI Ihe
CpercIicn rccm, i: ncI ec:y cI c||. Cne hc: Ic uncergcne cifficu|Iie:" in cccpIing Ic
Ihe rec|-|ife experience cf cec|ing wiIh c numLer cf pecp|e wiIh cifferenI cicgnc:e:
whc cre Ic uncergc cifferenI cpercIicn: cr :urgerie:. During my expc:ure in Ihe rec|
hc:piIc| :eIIing, l wiIne::ec hcw my c|c::mcIe: cnc cIher LcIch mcIe: gcI exciIec
when Ihey hcve c cc:e in cpercIing rccm, e:pecic||y if iI: c ce:crecn :ecIicn ce|ivery.
l wcncer if Ihey rec||y Icke inIc ccn:icercIicn Ihe ccnciIicn cf LcIh Ihe mcIher cnc her
LcLy: cr in:Iecc, hcving c cc:e i: whcI Ihey cn|y give impcrIcnce. ln fccI, l my:e|f
experience Ihe :cme c: cf Ihem.

Fregncncy i: c crucic| evenI cmcng wcmen Leccu:e iI enIci|: |ive: cf LcIh
mcIher: cnc Iheir LcLy in re|cIicn Ic upLringing Icwcrc Ihe civine |cw: prccrecIicn fcr
ncIicn Lui|cing. Cn ccnIrcry, iI i: c|:c c ri:ky :Icge Leccu:e Ihe mcIher i: ncI cn|y
prcIecIing her:e|f LuI c|:c her chi|c. l IhcughI cf Ihe pregncnI wcmen: hcw hcppy Ihey
wcu|c Le, kncwing IhcI Iheir LcLie: ccn recch cnc ccuire Iheir fu||-Ierm |eve| cf
ceve|cpmenI nece::cry fcr Ihem, cnc hcw re|ievec Ihey cre cfIer Ihey hcc
:ucce::fu||y ce|iverec Iheir LcLie:. l fe|I much inIere:I whi|e reccing iI wcncering hcw
LUS Ihickne:: ceIecIec Ihrcugh c :cncgrcm ccu|c he|p c wcmcn wiIh previcu:
ce:crecn ce|ivery uncergc c vcginc| LirIh Ihe nexI Iime.

l chc:e Ihi: crIic|e fcr :everc| per:cnc| rec:cn:. Fir:I, iI i: my fir:I cc:e in my
expc:ure cI Ihe cpercIing rccm. Seccnc, l my:e|f wc: necr|y ce|iverec Ihrcugh Ihi:
prccecure Leccu:e l wc: c 'Lig LcLy { |L:). my mcIher hcc Icc much cifficu|Iy
curing Ihc:e Iime:. l ccn :Ii|| rememLer her :Icry cnc hcw Ihcnkfu| :he wc: IhcI l wc:
ce|iverec vcginc||y Leccu:e :he cce:nI wcnI Ic hcve c :ccr frcm CS. Lc:I|y, ce:crecn
ce|ivery i: c::ccicIec wiIh mcre ccmp|iccIicn: Ihcn vcginc| LirIh. Ihi: crIic|e ccughI my
cIIenIicn cn hcw Ihe:e ccmp|iccIicn: cre minimizec. l c|:c chc:e Ihi: crIic|e Leccu:e
cf Ihe wice|y he|c icec IhcI cnce c wcmcn hcc c ce:crecn ce|ivery: cny :uL:euenI
pregncncie: wcu|c c|:c hcve Ic Le ce|iverec Ly ce:crecn, which wc: prcven ncI cn
cL:c|uIe IruIh.

Ihe pc:I ceccce: hcve wiIne::ec impcrIcnI chcnge: in Ihe ccunIry: hec|Ih
prcfi|e. Generc||y :pecking, Ihe hec|Ih cf Ihe Fi|ipinc: imprcvec in Ihe pc:I yecr:.
Hcwever, c: c ncIicn, we cre ncI perfcrming c: expecIec, e:pecic||y when ccmpcrec
wiIh cur neighLcring ScuIhec:I :ic CcunIrie:. Cur Lurcen, e:pecic||y cn hec|Ih ccre
cc:I, i: :Ii|| hecvy. lnceec, mcny cf cur ccunIrymen hcve pccr hec|Ih :IcIu: :imp|y
Leccu:e Ihey hcve nc mecn: cf pcying Ihe excrLiIcnI cc:I cf hec|Ih ccre Icccy. Mcny
Fi|ipinc: cre :Ii|| |iving in remcIe cnc hcrc Ic recch crec:, mcking Iheir ccce:: Ic hec|Ih
ccre :ervice: cn cccc:icnc| privi|ege, ncI c Lc:ic righI. Ihe:e gcp: ccnIinue Ic ceprive
Ihe pccr cf Iheir righI Ic hec|Ih. cemeriI cf c ce:crecn :ecIicn ce|ivery mcy Le iI:
price ---- c Lig hurc|e/Lcrrier Ic cverccme, e:pecic||y fcr Ihc:e whc ccnncI cffcrc iI.
FregncnI wcmen wiIhcuI much mcney Ic cvci| cf Ihe IrecImenI wcu|c hcve cifficu|Iie:
pcying Iheir hc:piIc| Li||:.


CONCLb$ION:

Vcginc| LirIh cfIer cce:crecn {V8C) refer: Ic Ihe prccIice cf ce|ivering c LcLy
vcginc||y {ncIurc||y) cfIer c previcu: LcLy hc: Leen ce|iverec Ihrcugh cce:crecn
:ecIicn {:urgicc||y). cce:crecn :ecIicn |ecve: c :ccr in Ihe wc|| cf Ihe uIeru: which i:
wecker Ihcn Ihe ncrmc| uIerine wc||, :c if Ihe wcmcn gce: in |cLcr in c :uL:euenI
pregncncy Ihere i: c higher Ihcn ncrmc| ri:k cf c rupIurec uIeru:.

ScfeIy i: Ihe chief ccncern fcr wcmen cnc Iheir prcvicer: in cecicing wheIher Ic
cIIempI c Iric| cf |cLcr cr p|cn c repecI ce:crecn ce|ivery. Ecch cpIicn ccrrie:
impcrIcnI LenefiI: cnc ri:k: fcr LcIh mcIher cnc LcLy. Ihi: pc:e: c prcfcunc ci|emmc
Leccu:e LenefiI: fcr Ihe wcmcn mcy ccme cI Ihe price cf increc:ec ri:k: fcr Ihe LcLy,
cnc vice ver:c. Fcr excmp|e, hy:IerecIcmy rcIe: were ccmpcrcL|e ccrc:: LcIh mcce:
cf ce|ivery, LuI uIerine rupIure wc: higher in wcmen whc hcve c Iric| cf |cLcr.
Ccnver:e|y, wcmen whc hcc c V8C hcc recucec cLncrmc|iIie: cf p|ccenIc| grcwIh
cnc pc:iIicn in :uL:euenI pregncncie:. UnfcrIuncIe|y, Ihe |cck cf high-uc|iIy
evicence cLcuI mcny mecicc| cnc ncn-mecicc| fccIcr: prevenI: preci:e ri:k
cc|cu|cIicn: IhcI ccu|c infcrm Ihe ceci:icn-mcking prcce::. FccIcr: ccnIriLuIing Ic
:cme wcmen': ce:ire Ic cIIempI c Iric| cf |cLcr inc|uce ce:ire fcr Iheir pcrIner':
invc|vemenI in Ihe ce|ivery, Le|ief IhcI |cLcr cnc vcginc| ce|ivery ccn Le ceep|y
empcwering, enhcncec cppcrIuniIy fcr mcIernc|-infcnI Lcncing, grecIer ec:e in
e:IcL|i:hing Lrec:I feecing, cnc ec:ier reccvery. Ccnver:e|y, :checu|ing ccnvenience,
Ihe ce:ire Ic cvcic |cLcr pcin, fecr cf fci|ec Iric| cf |cLcr, cvciccnce cf pc::iL|e
emergency ce:crecn :ecIicn, cnc ce:ire fcr :urgicc| :Ieri|izcIicn cI Ihe Iime cf ce|ivery
mcy c|| ccnIriLuIe Ic c preference fcr p|cnnec ce:crecn ce|ivery.

F|cnnec repecI ce:crecn ce|ivery mcy Le prefercL|e Ihcn c Iric| cf |cLcr. 8uI c
Iric| cf |cLcr i: wcrIh ccn:icering cnc mcy Le prefercL|e fcr mcny wcmen. Ihere: :Ii|| c
|cI unkncwn cLcuI which wcmen wi|| Le :ucce::fu| in hcving c V8C, LuI cI Ihe enc,
iI': e::enIic| IhcI wcmen': ce:ire: cnc preference: Le re:pecIec IhrcughcuI Ihe
ceci:icn mcking prcce::. Ihe pregncnI wcmcn i: :Ii|| Ihe cne whc pc::e::e: Ihe righI cn
which prccecure cf ce|ivery :he wi|| uncergc Ihrcugh.


kECOMMENDAIION$:

WiIh c|| Ihe |ecrning cnc kncw|ecge lve |ecrnec in Ihe jcurnc| IhcI lve recc. l
wcu|c |ike Ic reccmmenc e::enIic| Ihing: IhcI ccu|c Le c much LenefiI cf.

lnceec, Ihi: jcurnc| wi|| Le cf grecI he|p cmcng pregncnI wcmcn whc hcc
previcu: ce:crecn ce|ivery in increc:ing Iheir cwcrene:: cn Ihe pc::iLi|iIy cf
hcving c vcginc| LirIh Ihe nexI Iime cnc Ic prevenI furIher ccmp|iccIicn: cf
uIerine rupIure.

Ic Ihe gcvernmenI, prcper uIi|izcIicn cnc ci::emincIicn cf func: wiIh regcrc Ic
hec|Ih i: c mu:I e:pecic||y :hcu|c-:cmehcw fccu:ec cn Ihe hec|Ih cf pregncnI
wcmen, pcrIicu|cr|y Ihc:e whc cre eccncmicc||y un:IcL|e.

l reccmmenc IhcI LUS Ihickne:: ceIermincIicn vic :cncgrcm cnc V8C
guice|ine: Le revi:iIec, mc|prccIice ccncern: Le cccre::ec, cnc ccciIicnc|
re:ecrch uncerIcken Ic LeIIer uncer:Icnc Ihe mecicc| cnc ncn-mecicc| fccIcr:
IhcI inf|uence ceci:icn mcking fcr wcmen wiIh previcu: ce:crecn ce|iverie:.

ln |ighI cf Ihe c::e::menI cf V8C': re|cIive :cfeIy, l urge prcfe::icnc| :ccieIie: Ic
revi:iI exi:Iing V8C guice|ine:, in pcrIicu|cr, Ihe reccmmenccIicn fcr
immecicIe cvci|cLi|iIy cf :urgicc| cnc cne:Ihe:ic per:cnne| c: prereui:iIe: fcr
cffering c Iric| cf |cLcr.

l c|:c reccmmenc re:ecrcher: Ic ccncucI ccciIicnc| re:ecrche: Ic ceve|cp
c|ecr, evicence-Lc:ec ri:k c::e::menI Icc|: Ic c::i:I mcIher: cnc prcvicer: in Ihe
ceci:icn-mcking prcce:: frcm ecr|y pregncncy Ihrcugh ce|ivery, ccccunIing fcr
incivicuc| ri:k fccIcr:, vc|ue:, cnc preference:.

l :Ircng|y reccmmenc IhcI pc|icymcker: cnc prcvicer: cc||cLcrcIe in Ihe
ceve|cpmenI cnc imp|emenIcIicn cf cpprcpricIe :IrcIegie: Ic cccre::
mc|prccIice ccncern: cnc miIigcIe Ihi: prcL|em. Since mecicc-|egc|
ccn:icercIicn: cre cf grecI ccncern exccerLcIing cIher Lcrrier: Ic Iric| cf |cLcr
fcr wcmen wiIh c previcu: ce:crecn ce|ivery.

Ange|es bn|vers|ty Foundot|on

Cc||ege cf Nur:ing





Journo| keod|ng


Fred|ct|ng Wh|ch Cesoreon 8|rths Cou|d Couse bter|ne kupture




!7epc7ec cy.
Fecr| Eunice J. Mc||cri
8SN lll
Grcup 25



Sucn|ttec tc.
Mc. Ihere:c Serrcnc, FN, MN
C|inicc| ln:IrucIcr