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A Nationwide Study: Perception of Obstetricians in Malaysia on induction of labour for a patient with a single previous lower segment caesarean section Ganeshan Muniswaran , Sinthamoney E, Ravindran J. Objectives.

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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


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



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


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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