- Beyond the short term effects of caesarean delivery and gynaecological surgery
C.J.M. de Groot
- Award date
- 2 September 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
The work presented in this thesis focuses on the risk of maternal and neonatal complications in pregnancies after previous caesarean section and strategies for the prevention of post-surgical adhesion formation after abdominal and gynaecological surgery.
In Part One: "Pregnancy and delivery after caesarean section", we describe the value of lower uterine segment thickness measurement in the prediction of uterine defects during trial of labour in women who had a previous caesarean section. The course and outcome of consecutive pregnancies in women with a history of planned caesarean section and emergency caesarean section in first births is studied and we investigate the safety of trial of labour compared to elective repeat caesarean section after balancing covariates by propensity score matching. We compare neonatal and maternal outcomes of attempted operative vaginal delivery with emergency repeat caesarean section in trial of labour and we analyse the risks and discuss the possible reduction of caesarean section due to non-progression of labour.
In Part Two: "Prevention of post-surgical adhesions", we systematically reviewed all randomized clinical trials comparing surgical techniques in patients undergoing abdominal or pelvic surgery to obtain evidence of good surgical techniques that reduce adhesion formation. We end this thesis with the results of a pilot randomised controlled trial assessing the efficacy of a sprayable polyethylene glycol barrier in the prevention of de novo adhesions.
- Research conducted at: Universiteit van Amsterdam
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