Objectives

1. A Nationwide Study: Perception of Obstetricians in Malaysia on induction of labour for a patient with a single previous lower segment caesarean section GaneshanMuniswaran, Sinthamoney E, Ravindran J Objectives Induction of labour for a patient with a single previous uncomplicated caesarean section remains an area of great concern in obstetrics. The association of prostaglandins with uterine rupture, the reservations in using mechanical methods and the lack of concrete evidence on the best options of induction are among the challenges. Various centres and hospitals have their own guidelines and methods for induction of labour with lack on standardization. The perception, concerns and the medico-legal implications on the obstetrician remains vastly unknown which is equally of significance. Thus, the objective of this study was to evaluate the perception of obstetricians in Malaysia regarding induction of labour in patients with a single previous uncomplicated lower segment caesarean section. Table 4: Perceived best option of management Conclusions Methods There appears to be little consensus on how best to manage a patient with a previous untested caesarean section The majority were concerned regarding the adverse outcomes and a significant number of obstetricians were not keen to utilise prostaglandins in these patients. Protocols are not widely standardised. As the medico-legal implications of inducing labour in such patients are significant, there is an urgent need for evidence based guidelines for the management of such patients. It is also important to monitor and audit such patients, which is best done by establishment of a national registry. This was a prospective study. A standardised questionnaire was posted to every single registered member of The Obstetrics and Gynaecology Society of Malaysians, which is the major organization representing Obstetricians and Gynaecologists in Malaysia. The questionnaire evaluated a wide spectrum of perceptions of obstetricians on current practice of labour induction in patients with a previous uncomplicated caesarean section. This included the timing, dosage, protocol, adherence to protocol and their personal perceptions. Furthermore, their perceptions on the safety of prostaglandins, its medico legal implications and the perceived best option of care were studied. The results were analyzed using Microsoft Excel 2007. Table 2: Obstetricians’ perception References • Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev 2006;(4). • Landon MB, Leindecker S, Spong CY, et al. The MFMU Caesarean Registry: Factors affecting the success of trial of labour after previous caesarean delivery. Am J ObstetGynecol 2005; 193:1016–1023. • Royal College of Obstetricians and Gynaecologists Induction of labour. Evidence Based Clinical Guideline No 9, Clinical Effectiveness Support Unit, RCOG, June 2001. London: Royal College of Obstetricians and Gynaecologists; 2001. • McDonagh MS, Osterweil P, Guise JM. The benefits and risks of inducing labour in patients with prior caesarean delivery: a systematic review. BJOG 2005; 112:1007–1015. • American College of Obstetrics and Gynaecology. Practice Bulletin Number 54: Vaginal birth after caesarean. ObstetGynecol 2004; 104: 203–212. • ACOG Task Force on Caesarean Delivery Rates. Evaluation of caesarean delivery. American College of Obstetricians and Gynecologists. Washington, DC: ACOG; 2000. • Emmett CL, Shaw AR, Montgomery AA, Murphy DJ, DiAMOND study group. Women’s experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks. BJOG 2006;113:1438–45. • Frost J, Shaw A, Montgomery A, Murphy DJ. Women’s views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: qualitative interview study. BJOG 2009;116:896–905. • Rees KM, Shaw ARG, Bennert K, Emmett CL, Montgomery AA. Healthcare professionals’ views on two computer-based decision aids for women choosing mode of delivery after previous caesarean section: a qualitative study. BJOG 2009;116:906–14. • Society of Obstetricians and Gynaecologists of Canada. SOGC clinical practice guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155, February 2005. Int J GynecolObstet 2005; 89:319–331 Results The society has 620 registered obstetricians as its members and 193 (31.1%) of them participated in this study. Table 1: Presence of protocol in clinical practice Table 3: Concern in terms of medico-legal implications