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PubMed1975

[Locked twins].

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Delivery, Obstetric↗
PubMed1975

Community obstetrics in an urban situation.

The majority of the world's population is of poor economic status, and this is commonly associated with high fertility levels and high infant mortality and morbidity. This population can be divided into two main groups: those in over-populated urban areas and those in scattered rural areas. Both groups have their peculiar problems and comprehensive maternal and child health is a formidable task. This paper is an account of the obstetric services in an urban population in the municipality of Salisbury, Rhodesia, where there is close co-operation between hospital and municipal authorities and all high-risk maternity patients are delivered in hospital and low-risk ones in municipal maternity units. Methods of selection of patients and results obtained are shown.

Cesarean Section↗
PubMed1976

[On the optimal method of delivery in breech presentation (author's transl)].

Between 1966 and 1974, 90% of 581 single breech presentations were delivered vaginally. The incidence of Caesarean Section was 9.5%. The overall perinatal mortality was 14%. After elimination of premature deliveries under 1000 grams, stillbirth prior to labour and non-viable anomalies, the perinatal mortality was 5.6%. The perinatal mortality in infants over 2500 grams was 0.69%.

Birth Weight↗
PubMed1992

Labour management. Our experience.

We report a retrospective analysis of 1202 deliveries assisted by the same medical team, evaluating the clinical management of labour and the resulting type of delivery. Examination of the data revealed a gradual reduction in the number of deliveries treated pharmacologically accompanied by a reduction in the incidence of operative deliveries from 16% to 6%. Statistical analysis of the data using X2 test demonstrated a clear correlation between the administration of oxytocin and the incidence of operative deliveries (p less than or equal to 0.001). We believe that the indiscriminate use of oxytocin in labour should be avoided and that the pharmacological and operative management of labour requires precise clinical indications.

Adult↗
PubMed1991

The management of the second stage of labour in primiparae with epidural analgesia.

One hundred and ninety-four primiparae with lumbar epidural analgesia established during the first stage of labour were discouraged from pushing until the fetal head was visible at the perineum or until three hours had elapsed since full dilation of the cervix. The outcome in this group was compared with a similar group in whom pushing was commenced as soon as the second stage was diagnosed. The observed increase in spontaneous deliveries did not reach statistical significance. There was a reduction in non-rotational forceps (p less than 0.05), but no change occurred in the incidence of rotational forceps deliveries. The high rates of oxytocin augmentation in these primiparous labours may account for the failure of delayed pushing to increase the spontaneous delivery rate in our population.

Analgesia, Epidural↗
PubMed1991

[Delivery of large infants. Management and results of 198 cases].

We have studied the deliveries of 198 large fetuses over a period of 3 years between 1st January 1987 and 31st December 1989 in the University Hospital of Poitiers. By large fetus we mean the delivery of a child of 4,000 grammes or more. This occurs in 4.5% of deliveries. The following risk factors are present either singularly or together with others: previous delivery of a large child (12.6%), a previous history of pregnancy diabetes or its absence (2.5%), an increase of weight during pregnancy of more than 15 kgs (46.8%), obesity before the onset pregnancy (19.7%), the height of the uterus equal to or above 35 cms (75.8%). These factors were found in nearly 90% of the patients. Their presence should make one look for a large fetus. The obstetrical results were as follows: 18 ceasareans were carried out (9.09%); instrumental delivery was necessary in 43 cases (23.8%); there were 17 cases of shoulder dystocia treated by obstetrical manoeuvres (9.5%). There were therefore 122 vaginal deliveries without any interference (61%). Neonatal complications were: one lost because of malformation (0.5%), serious morbidity in 30 deliveries (15.15%); 16 fractures of the clavicle and two cases of brachial plexus paralysis of which one persisted, two facial palsies which recovered, six infections, three cases of hypoglycaemia and one serious fetal distress which recovered without any sequelae. Maternal complications were: no mortality, serious morbidity in 26 women (14.1%), 9 haemorrhages at delivery, 9 cases of trauma of the perineum, 6 infections, and 2 haematomata in the episiotomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Low-dose intrathecal morphine sulphate as sole analgesic for pain of labour in combination with elective forceps delivery. A report of 10 cases.

Preservative-free morphine sulphate (0.5 mg in 0.5 ml normal saline) was injected intrathecally as the sole analgesic in 10 primiparous patients in the first stage of labour. Elective forceps were applied under pudendal block anaesthesia to assist the second stage of labour to prevent cephalad spread during bearing down, and so reduce the side-effects of morphine sulphate. All patients reported good analgesia during the first stage of labour. There was no loss of the bearing down reflex and, except for mild peri-oral itching in 6 patients, no side-effect attributable to intrathecal morphine was noted. No side-effects of morphine sulphate were observed in any of the infants delivered. It is concluded that intrathecal morphine sulphate combined with elective forceps delivery provides a satisfactory alternative to epidural anaesthesia in those patients whose cardiovascular status demands preservation of a normal or elevated systemic vascular resistance.

Adolescent↗
PubMed1979

Mode of delivery and developmental characteristics in a thousand Dunedin three year olds: a report from the Dunedin Multidisciplinary Child Development Study.

A study of 1037 representative Dunedin children delivered by a variety of modes was described. The results showed that there were no significant differences in maternal general mental ability, training in child development, or background of child experiences among the five delivery groups studied. Also, there were no significant differences between children who were spontaneous deliveries or any of the other groups in age at which the developmental milestones were achieved, nor in any of the developmental characteristics assessed.

Breech Presentation↗
PubMed1977

[Assisted delivery of the calf by manual or mechanical traction (author's transl)].

During the past few years, an increasing number of farmers examined cows at parturition and attempted delivery of calves. Frequently, the veterinarian is merely called in to perform caesarean section. From the point of view of obstetrics, quite a number of caesarean sections could have been avoided if a thorough examination of the cow had been made. Examination and treatment of cows at parturition is described in detail. Particular attention is paid to the mechanical features of delivery. The advantages and disadvantages of manual and mechanical traction are discussed.

Animals↗
PubMed1976

[The optimal caesarean section rate in breech deliveries (author's transl)].

A critical review of 535 breech deliveries over 15 years is presented and compared to the present trend to deliver all primigravida breech presentations by Caesarean Section. Management of the labour and delivery in view of a vaginal delivery was started in 84% of the cases. The Caesarean Section rate was 16%. The prenatal mortality compared well to that reported in the literature. The relatively high total morbidity of 3.2% showed the increased risk for the infant of the primigravida (1.9%) and of the multigravida (1.7%). 1.5% of the infants were transferred to the pediatric department because of birth trauma. All children with birth trauma were delivered prior to the increase of the Caesarean Section rate from 9.2% to 21.2%. Since 1969 the fetal morbidity was 0% for breech deliveries.

Birth Injuries↗