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\begin{document}

\title{Adopting the O'Driscoll regime may optimize caesarian section rate in
the primiparous woman.}



\author[1]{Peter Petros}%
\affil[1]{University of Western Australia}%


\vspace{-1em}



  
  \date{May 04, 2024}


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Professor PEP Petros DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG
(Lond)

31/93 Elizabeth Bay Rd, Elizabeth Bay NSW 2011 AUSTRALIA

Reconstructive Pelvic Floor Surgeon and Certified Urogynaecologist
(retired)

Formerly University of NSW Professorial Dept of Surgery, St Vincent's
Hospital Sydney (retired)

Adjunct Professor, University of Western Australia School of Mechanical
and Chemical Engineering, Perth WA (current)

Tel 61 2 9361 3853 Cellphone (AUST) 61 411 181 731

Email pp@kvinno.com website www.integraltheory.org

\textbf{Re Global rising rates of caesarean sections}

\emph{Patrick Chien}

First published: 05 March 2021

\emph{https://doi.org/10.1111/1471-0528.166}

\textbf{No of words 441}

\textbf{Conflicts None}

\textbf{Funding NIL}

The Editors

BJOG

\textbf{Running head} O'Driscoll regime may optimize CS rate

\textbf{Adopting the O'Driscoll regime may optimize caesarian section
rate in the primiparous woman.}

\emph{Dr Chen asks, ``What is the optimum rate of caesarean section
delivery? This is a question that has bedevilled many obstetricians over
the last half century.''{[}} 1{]} We believe our recently published
OASIS study may shed some light on this important question, albeit from
a different angle. We examined the effect of passive management of
labour on OASIS {[}2{]} and found that the O'Driscoll active management
method vastly reduced OASIS in primiparas without increase in caesarian
section (CS). Routine adoption of this method may go a long way towards
answering Dr Chen's question. The genius of the O'Driscoll method is
that it is a ``zero sum''*protocol which is tailors CS to an individual
patient. It automatically takes into account all three ``Ps'', powers,
passengers, passages, irrespective of which one is causing the problem.

*it will come through in 12 hours, or it will not. If not, a CS is
performed.

We carried out a comparative study of third and fourth degree anal
sphincter tears in all primiparas delivering at term in the years
2010--2015 in six Sydney public teaching hospitals, which were under
MANDATORY direction from the Director General of NSW Health for labour
to proceed without augmentation. The study comprised 130,000 women. We
compared teaching hospital data with data from patients delivered in six
adjacent Sydney private hospitals which used augmented labour. A second
comparator was from the National Women's Hospital, Dublin, where the
O'Driscoll active management is performed under midwife direction. The
mean third and fourth degree anal sphincter tear rate was 8.17\% for NSW
public teaching hospitals, 1.52\% for the adjacent private hospitals in
the same period (p \textless{} 0.0003) and 2.6\% for NWH Dublin. The
emergency CS rate between 2010--2015 was 13.7\% private, 12.7\% public,
7.9\% NHW Dublin. However, there was an increase in rate of epidurals,
forceps/ventouse and lower Apgar scores in NSW public hospitals.

We attributed the rise in OASI to poor contractions causing deflexion of
the head, increasing the cephalic diameter from 9.5cm to 11.2 cm with
consequent increased stress on the sphincters.

In an accompanying editorial {[}3{]}, we examined the longer-term
damaging effect of a larger diameter head pushing through the pelvis on
the ligaments, tissues and muscles with regard to future prolapse,
bladder, bowel symptoms. In this context, we described OASIS as ``the
canary in the coalmine'', a harbinger of such problems in the future for
the OASIS women.

It would seem that the O'Driscoll active management regime, which limits
labour to 12 hours without increasing the caesarean section rate, may
not only protect from OASIS, POP and incontinence, but also, provide an
optimum caesarian section rate \emph{for the individual woman.}

\textbf{References}

Patrick Chien Global rising rates of caesarean sections BJOG

First published: 05 March 2021 https://doi.org/10.1111/1471-0528.166

Beale RM Petros PE Passive management of labour may predispose to anal

sphincter injury Int Urogynecol J. 2020 Sep;31(9):1943-1947. doi:
10.1007/s00192-019-04183-6. Epub 2020 Jan 7.

Peter~Petros~, Mark Richard Beale , Burghard Abendstein
\ldots{}~Editorial

The~mechanics~and~biomechanics~of~OASIS POP~and~incontinence-is~active
management~of~labour protective? \ldots{}~management~of~labour
protective? Int Urogynecol J.~2020~Sep;31(9):1727-1728. doi:
10.1007/s00192-020-04279-4.

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