Risk of Uterine Rupture and Placenta Accreta With Prior Uterine Surgery Outside of the Lower Segment

Objective—Women with a prior myomectomy or prior classical cesarean delivery are often delivered early by cesarean due to concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. Methods—Women with prior myomectomy or prior classical cesarean delivery were compared to women with a prior low transverse cesarean to estimate rates of both uterine rupture and placenta accreta. Results—One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low transverse cesarean were evaluated. Mean gestational age at delivery differed by group (p0.99) or in the prior classical cesarean delivery group (0.88%, p=0.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of prior myomectomy compared with 0.19% in the low transverse cesarean group (p>0.99) and 0.88% in the prior classical cesarean delivery group (p=0.01 relative to low transverse cesarean). The adjusted OR for the prior classical cesarean delivery group (relative to low transverse cesarean) was 3.23 (1.11-9.39) for uterine rupture and 2.09 (0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the prior classical cesarean delivery and 13.6% for low transverse cesarean groups (p>0.99=1.0). Conclusion—A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low

Socioeconomic performance of West African fleets that target Atlantic billfish

Managing marine resources is a contentious and complicated process. There are various users with competing objectives, especially in the case of artisanal and recreational fisheries management. Managers must consider not only the biological sustainability of the resources, but also account for the socioeconomic objectives of the fishery users, particularly in developing countries. In-person surveys were implemented with artisanal fishers that target billfish in Ghana and with recreational charter boat anglers that target billfish in Senegal. Data from the survey were used to compile financial performance indicators that describe the sustainability of the operations. In addition social and resource management perception data were collected in each location. The results of the study indicate that both fleets exhibit positive profit levels. Although fishers in both study locations perceived a declining billfish resource, they were largely unwilling to accept management measures to improve the resource. If management measures were to be considered for the artisanal fleet, managers should simultaneously introduce mechanisms to improve the technological storage capacity of harvested fish and training on saving schemes for artisanal fishers. Managers should also monitor the number of recreational vessels and their effort in Senegal. Performance indicators such as these are applicable and appropriate for quantitatively assessing the profitability of fishing fleets