At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

An animated description of the composition of bones.

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German Video showing examination of the urinary bladder

Ultrasound guided Femoral Nerve stimulating Catheter

Plantar warts are hard, grainy growths that usually appear on the heels or balls of your feet, areas that feel the most pressure. This pressure also may cause plantar warts to grow inward beneath a hard, thick layer of skin (callus). Plantar warts are caused by the human papillomavirus (HPV). The virus enters your body through tiny cuts, breaks or other weak spots on the bottom of your feet. Most plantar warts aren't a serious health concern and may not require treatment. But plantar warts can cause discomfort or pain. If self-care treatments for plantar warts don't work, you may want to see your doctor to have them removed.

Surgical site infections (SSIs) remain a prevalent threat to patient safety. Proper surgical hand scrub or rub techniques are essential to decreasing the incidence of SSIs. This video provides instructions on the anatomical surgical hand scrub procedure using the brushstroke method. Learn more from the Department of Hospital Epidemiology and Infection Control (HEIC) at The Johns Hopkins Hospital: http://www.hopkinsmedicine.org/heic

Myelomeningocele remains the most complex congenital malformation of the central nervous system that is compatible with life. This lesion results when the neural tube fails to fold normally during postovulatory Days 21 to 27.[6] The exact cause of disorders remains under some historical debate and is not within the scope of this paper. Myelomeningocele within the context of this discussion refers only to lesions that involve an open caudal neural tube defect on the surface of the skin

Medical Female Breast Exam

Thoracoscopic Management of Lung Abscess Before Empyema

Watch that video to know How to Get Pregnant Fast and Easy

Hemorrhoidectomy Operation Video

This video demonstrates a manual small incision cataract surgery using a Blumenthal technique, in a white cataract.

Surgeon: Dr. Rishi Swarup, FRCS, Medical Director & Senior Consultant, Swarup Eye Centre, India

Learn about the structural unit of compact bone (the osteon) and it's four basic parts: central canal, lamellae, lacunae, and canaliculi

Bate's Visual Guide Pediatric Head-to-Toe Assessment

Most babies will move into delivery position a few weeks prior to birth, with the head moving closer to the birth canal. When this fails to happen, the baby’s buttocks and/or feet will be positioned to be delivered first. This is referred to as “breech presentation.”

Finger Abscess Incision and Drainage. Digital block with drainage.

Surgery. A procedure to remove an epididymal cyst is carried out under general anaesthetic and involves removing the cysts through a small incision in your scrotum that is sealed with dissolvable stitches.

How did Mr Bean get himself into pretending to be a doctor?

Macrobiopsy of breast lesions is a complicated procedure when performed with vacuum assisted biopsy tools. The Spirotome is a hand-held needle set that doesn't need capital investment, is ready to use and provides tissue samples of high quality in substantial amounts. In this way quantitative molecular biology is possible with one tissue sample. The Coramate is an automated version of this direct and frontal technology.