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PubMed1999

[Epidural analgesia in cases of placental dysfunction].

EDA has a favourable influence on uteroplacental perfusion. Data containing 262 deliveries with EDA followed pathological pregnancies were investigated by the authors. Their parameters were compared to 143 deliveries without pathological change and to the general obstetrical data of the Ward. In these groups the Apgar scores of the newborn babies, the duration of deliveries, the frequency of the delivery completing operations were studied and the complications of the intervention were surveyed.

Analgesia, Epidural↗
PubMed1996

[Deliveries at a department of surgery during a 10-year period].

In order to see whether the pattern of referral of pregnant women, intervention during labour and transport of neonates had changed over a 10-year period, we investigated these variables in the women who gave birth at our department of surgery in 1978, 1981 and 1988. The numbers of women were 790, 630 and 697 respectively for the three years, and the corresponding numbers of neonates transferred to the neonatal unit were 56, 44 and 53 respectively. The frequencies of risk pregnancies increased from 20% in 1978 to 37.7% in 1999, (p < 10(-6) and the frequency of primiparity increased from 43% to 51.2% over the same period (p < 10(-5)). More women underwent elective caesarean section due to an increased number of breech presentation in nulliparous women (p < 10(-3)). The frequency of induction of labour decreased from 21.7% to 16.5% (p < 10(-6)). The perinatal mortality ranges between 0% to 0.48% during the 10 years, and the rates of transfer of neonates to the neonatal unit were unchanged (7.1-7.6%). It is concluded that changes in referral and composition of the population had no influence on the incidence of acute intervention in labour or rate of neonatal transfer.

Adult↗
PubMed2001

The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes.

OBJECTIVE: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery. STUDY DESIGN: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries. RESULTS: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations. CONCLUSION: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.

Adult↗
PubMed1997

Management and outcomes of posterior fossa subdural hematomas in neonates.

OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. METHODS: A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning. RESULTS: There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean 5-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth. CONCLUSION: PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.

Birth Injuries↗
PubMed2001

[Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome].

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.

Adult↗
PubMedDate not supplied

[Significance of the site of uterine contraction for labor progress and duration of pregnancy].

A four-channel topographic technique was developed in order to improve information about spatial uterine motility. 54 women were monitored during delivery. Four pressure transducers were attached in a square around the umbilicus. Most frequently the origin of labour could be determined in the upper right segment of the uterus. The rate of operative deliveries was decreased in case of predominant upper right origin of labour. The majority of contractions with clear propagation patterns originated at the upper right site, continued to the left and then to the lower right part of the uterus. The highest relative intensity was also measured at the upper right site. Predominant upper right origin of labour may be important for undisturbed delivery. The probability of a preterm delivery is increased in case of an upper right origin of labour.

Adult↗
PubMed2000

[Choice of delivery method in multiple pregnancy. I. Twins].

From 1995 till 1998 year 174 twin pregnancies were delivery at the SUH "Majchin Dome" in Sofia. The methods, applied for delivery was: per vies naturalis 78 (51, 32%) women (normal vaginal delivery 63 pregnancies, breech delivery--12, with vacuum extractor--2 and with forceps--1); by cesarean section was delivered 74 (48, 68%). The 80 pregnancies with premature delivery (under 37 g.w.) were delivered by: normal vaginal delivery--(55.13%) and cesean section--37 (50%). Indication for operative delivery were: irregular position--45, sterilitas primaria--13, EPH Gestosis--12, asphyxia intrpartum--9, previous cesarean section--3, luxatio coxe congentia--4, age over 31 years--4, abruptio placente--2, condilomata acuminata--2. We not find significant difference in experience on new-born depending on the method for delivery after 35 g.w. We find the best experience by new-born, delivered with cesarean section between 28-33 g.w. and 33-35 g.w. (50% and respectively 100%) compared to delivered per vies naturalis (43.75% and 86.36%). The authors consider the it is desirable liberation on indications for delivery with cesarean section by the twins between 28-35 g.w.

Breech Presentation↗
PubMed1993

[Course of pregnancies and labors in a department of general surgery. A prospective study of pregnancies during a 1-year period at Hørsholms hospital].

The complications of pregnancy and delivery in a material consisting of 841 women without obstetric risk factors were investigated. The deliveries were planned to take place in a department of general surgery with a specialist obstetrician. Seventy-five women (8.9%) were transferred to a specialized obstetric department before delivery, 14 women (1.7%) because of imminent premature delivery. In addition, 69 women were transferred because of removal or their own wish for transfer. A total of 631 patients (90.5%) were delivered vaginally and 66 (9.5%) were delivered abdominally. In thirty-five of these, caesarean sections were performed during the course of delivery. In 34 deliveries (5.1%) vacuo extraction was used. Among 181 women (27.1%), unexpected complications occurred, 80 of these women (12.0%) requiring emergency treatment. A total of 697 infants were delivered. One infant died before delivery because of placental separation. Twenty-two infants (3.2%) were transferred to a paediatric department during the neonatal period, three because of asphyxia. Three of the liveborn infants (0.4%) had Apgar scores at 1 minute between 0 and 3, 40 infants (5.7%) had scores between 4 and 6. After 5 minutes, no infants had Apgar scores between 0 and 3, but three infants had scores between 4 and 6. It is concluded, that the low perinatal mortality and morbidity might indicate, that deliveries in a department of general surgery are safe, provided a specialist obstetrician is available and the rules of referral strictly observed.

Apgar Score↗
PubMed2002

Mode of delivery and risk of developing allergic disease.

The aim of this study was to quantify the relationship between mode of delivery and subsequent incidence of allergic disease. The analysis is based on data derived from a birth cohort of 24,690 children who contributed data to the West Midlands General Practice Research Database. We found no convincing evidence to suggest that babies born by caesarean, forceps, or breech delivery had an increased risk of developing allergic disease.

Asthma↗
PubMed1984

Serum cortisol levels of maternal vein, umbilical artery, and umbilical vein classified by mode of delivery.

We measured maternal venous (MV), umbilical arterial (UA), and umbilical venous (UV) cortisol levels of 180 pregnancies at term. The cortisol level of MV was higher than that of UA and UV in all deliveries. The cortisol levels of three samples had no difference between the induced labor group and the spontaneous onset of labor group regardless of delivery mode. In spontaneous vaginal delivery the cortisol levels of three individual samples were significantly higher in primipara than in multipara. The positive correlations were observed in any modes of deliveries between the cortisol levels of MV and UA, and MV and UA and UV. These data suggest that the fetus may produce cortisol by itself and maternal cortisol may inflow to the fetus.

Breech Presentation↗
PubMed2005

Pregnancies and deliveries in patients with Charcot-Marie-Tooth disease.

OBJECTIVE: To investigate the effect of maternal Charcot-Marie-Tooth disease (CMT) on pregnancy and delivery. METHODS: Data from the Medical Birth Registry of Norway 1967 to 2002 were surveyed. This registry has compulsory notification of all births. One hundred eight births by mothers with CMT were identified. The reference group consisted of all 2.1 million births by mothers without CMT. RESULTS: Women with CMT had a higher occurrence of presentation anomalies (9.3 vs 4.5%; p = 0.04) and bleeding post partum (12.0 vs 5.8%; p = 0.02). The rate of operative delivery was twice that of the reference group (29.6 vs 15.3%; p = 0.002), and forceps was used three times as often in the CMT group (9.3 vs 2.7; p < 0.001). The majority of CMT cesarean sections were emergency sections. CONCLUSION: Charcot-Marie-Tooth disease increases the risk for complications during delivery, which is linked to a higher occurrence of emergency interventions during birth.

Adult↗
PubMed2003

Outcome of induced labour in pregnancies at 41 weeks gestation and over in Saudi Arabia.

A retrospective, descriptive cohort study was conducted at King Faisal Military Hospital, Saudi Arabia, to compare pregnancy outcomes in patients induced with prostaglandin E2 from 41 weeks gestation. A total of 450 women whose antenatal care and delivery were conducted at the hospital during 1995-99 were studied. The main outcome measures used were caesarean section rate and perinatal morbidity and mortality. In otherwise normal pregnancies, the caesarean section rate was not significantly increased when induction of labour was carried out at 41 weeks gestation compared with > or =42 weeks. Although more perinatal complications occurred when induction was carried out at 42 weeks, the results were not statistically significant. A large prospective clinical trial is indicated.

Analysis of Variance↗
PubMed1996

The quality of abortion services in Turkey.

The quality of abortion in Turkey's public sector hospitals is investigated using multiple research methods including observations of actual procedures, interviews with medical staff and clients, and an inventory of materials and equipment. The results suggest that women who obtain abortions in public sector hospitals have a higher abortion rate than the general population. They are likely to receive a vacuum aspiration with minimal pain control medication. Clinical infection control procedures are insufficient, as are interpersonal communication practices including counseling on reproductive health issues and providing factual information. Links with family planning services are strong and the majority of abortion patients who desire family planning receive a contraceptive method, either through direct provision of postabortion contraceptives or referral.

Abortion, Induced↗