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PubMed1995

[Ultrasound of extremity lesions caused by birth trauma].

With regard to injuries of the extremities caused by birth trauma, ultrasound allows simultaneous direct evaluation of the surface of osseous elements and of cartilaginous and soft-tissue structures as well. Thus, not only fractures, but also concomitant articular fluid collections, respectively haematomas and/or dislocation of an epiphysis are demonstrated in their initial extent and in their course of healing. Additionally, closed repositions, for instance of a displaced epiphysis, can be exactly monitored by ultrasound. A reduced number of roentgenograms as well as renunciation of other imaging modalities are the consequence. Own experiences in 4 patients with birth trauma to the humerus confirm the high validity of ultrasound in this area as well.

Arm Injuries↗
PubMed1993

[Pressure on the fetal head in vacuum extraction].

The pressure exerted on the foetal head was continuously measured with a specially designed instrument in 4 children delivered by vacuum extraction because of arrested delivery. The results were compared with the values obtained in spontaneous deliveries. Lower head pressure values were found in the vacuum group, with a head pressure to amniotic pressure ratio < 1 (normal > 1) before application of the cup. During extraction the head pressure exceeded the intraamniotic pressure. Normal progress of labour requires not only sufficient intrauterine pressure but also an adequate pressure transmission to the presenting part that must widen the birth canal. A prolonged course of labour may therefore be associated with increased pressure values due to elevated resistance of the birth canal as well as with decreased pressure values due to insufficient transmission of pressure. Hence, the load of the foetal head during uterine contraction cannot be determined from the duration of birth.

Adult↗
PubMed2001

Vaginal birth after cesarean among women with gestational diabetes.

OBJECTIVE: We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December 31, 1999. One hundred fifty-six women with gestational diabetes were matched with 272 control subjects. Data were analyzed with the Student t test, chi2 analysis, and the Fisher exact test. RESULTS: The parities of the women with gestational diabetes and the control subjects were similar, with most having had only one previous pregnancy. Women with gestational diabetes were significantly older than control subjects and more likely to be white or Hispanic. Women with gestational diabetes who attempted a trial of labor were significantly more likely than control subjects to be delivered abdominally. Women with gestational diabetes who had a successful vaginal birth after cesarean were significantly more likely than control subjects to have an operative delivery with forceps or vacuum. CONCLUSION: Women with gestational diabetes are less likely than those without diabetes to have a successful trial of labor. Women with gestational diabetes considering vaginal birth after cesarean should be appropriately counseled about the risk of attempting a trial of labor after previous cesarean delivery.

Adult↗
PubMed1991

Relationships between intellectual control beliefs and psychometric intelligence in adulthood.

This longitudinal study examined perceived control of intelligence and its relationship with intellectual performance. A large sample (ages 43-84) was administered the short form of Lachman's PIC and psychometric tests of eight intellectual abilities in both 1985 and 1987. There were significant cross-sectional age differences in the three scales: Internal (INT), Powerful Others (POW), and Chance (CHA). The three scales correlated with all intellectual abilities, with relationships being largest for POW. The PIC scales showed lower test-retest correlations than the intelligence tests. Individual differences in change in POW and CHA were also correlated with prior levels of psychometric intelligence, and path analyses suggested a small but significant prediction of change in POW by prior levels of intelligence.

Adult↗
PubMed2001

Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage.

BACKGROUND: Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first randomized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage. METHODS: Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999. They were randomized to group 1: misoprostol; and group 2: expectant management. Women in the misoprostol group received vaginal misoprostol 400 microg on days 1, 3 and 5. The expectant group was followed up according to the same schedule. Suction evacuation was performed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15. RESULTS: Fifty-nine women completed the trial. Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful. The incidence of side-effects was comparable between the two groups. Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding. The mean duration of vaginal bleeding was similar for both groups (14.6 days in the misoprostol group versus 15.0 days in the expectant group). The successful rate in the misoprostol group was significantly higher than that of the expectant group (83.3 versus 48.3%, P < 0.05). CONCLUSION: We recommend repeated vaginal misoprostol 400 microg given on days 1, 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage.

Abortion, Spontaneous↗
PubMed1978

Reduced dose of Rh immunoglobulin following first trimester pregnancy termination.

The efficacy and safety of a 50-microgram dose of Rh immune globulin for prevention of Rh isosensitization following first trimester vacuum abortion are evaluated in this study. A total of 1027 women undergoing abortion at three outpatient facilities participated in the study; 755 (73.5%) completed follow-up serologic screening 6 months after termination of pregnancy. None showed serologic evidence of Rh sensitization at the time of followup. No serious adverse reactions to the drug were observed.

Abortion, Induced↗
PubMed1985

Amniotic fluid embolism. Three case reports with a review of the literature.

Amniotic fluid embolism is a catastrophic event of the intra- and early postpartum period which may also be seen with cesarean delivery and during abortions. Presenting symptomatology includes respiratory distress with cyanosis, shock, and possibly tonic-clonic seizures. DIC frequently occurs. The pathogenesis may include entry of amniotic fluid through lacerations or ruptures of the uterus or cervix, through endocervical veins and through abnormal uteroplacental sites, such as with placental abruption, placenta previa, or placenta accreta. Amniotic fluid probably causes cardiovascular-respiratory symptoms by pulmonary vascular obstruction and through a vasoactive substance causing pulmonary vascular constriction. The lethality of amniotic fluid may be enhanced by a high particulate content or meconium staining. The diagnosis of amniotic fluid embolism may be made ante mortem by demonstrating amniotic fluid debris in central blood samples or expectorated sputum. Postmortem diagnosis often requires meticulous examination of the pulmonary microvasculature with the utilization of special stains. Treatment is directed towards symptoms of shock, arterial hypoxemia, and DIC. Acute renal failure may complicate the picture after shock. If the patient survives the embolic and coagulative problems, recovery is usually complete without long-term sequelae.

Abortion, Missed↗
PubMed2006

Head injuries after instrumental vaginal deliveries.

PURPOSE OF REVIEW: The types, mechanisms and clinical manifestations of head injuries (extracranial, cranial and intracranial) after instrumental delivery are described along with current evidence of their prevention and management. RECENT FINDINGS: Asymptomatic subdural hematomas can occur in up to 6.1% of uncomplicated vaginal deliveries. Maternal nulliparity, incorrect placement of vacuum extraction cup and failed vacuum extraction are predisposing factors to subgaleal hemorrhage. Injuries associated with the vacuum devices may be minimized if the recommended limits for a safe traction force are not exceeded. There is no difference in the incidence of scalp trauma between vacuum deliveries by a rigid plastic cup (Omnicup) and the standard, silastic cup. The use of a metal cup may increase the occurrence of head injuries. Protective covers over forceps reduce the rates of neonatal facial abrasions and skin bruises. There is no difference in the incidence of cephalhematoma comparing a sequential operative vaginal delivery and a caesarean section following a failed vacuum delivery. SUMMARY: Instrumental vaginal deliveries carry substantial risks. Only practitioners who are adequately trained or are under supervision should undertake instrumental delivery. The mode of intervention needs to be individualized after consideration of the operator's skills and experience and the clinical circumstances.

Birth Injuries↗
PubMed2003

Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction.

Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and underdiagnosed. The vacuum extractor is being advocated as the instrument of first choice for assisted vaginal delivery, but appears to be associated with an increased incidence of subgaleal hemorrhage. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. Because of the ease of application, vacuum extractors could be used potentially in circumstances in which forceps would not be attempted, allowing an operator of average experience to perform rotational deliveries. The worrisome increase in the incidence of subgaleal hemorrhage associated with vacuum extraction leads to the issuance of warnings from governmental authorities in Canada and the United States. This review discusses the anatomy of this lesion, etiology, clinical presentation, management, and possible prevention.

Birth Injuries↗
PubMed1996

Birth by vacuum extraction: neonatal outcome.

Subgaleal (subaponeurotic) haemorrhage (SGH) is a serious and sometimes life-threatening condition associated with vacuum extraction. With increasing use of the vacuum extractor as the preferred instrument for assisted vaginal delivery, neonatal paediatricians should be prepared to encounter a greater number of infants with SGH and other effects associated with vacuum extraction. In order to reduce morbidity and to prevent mortality in infants with SGH, neonatal caregivers should be able to recognize the occurrence of this type of bleeding and to institute appropriate forms of management. This annotation describes the effects of vacuum extraction on the newborn infant and suggests some measures for the management of these conditions.

Female↗
PubMed1980

The use of 16-16 dimethyl trans delta 2 PGE1 methyl ester (ONO 802) vaginal suppositories for the termination of early pregnancy. A comparative study.

Vaginal suppositories containing the 16-16 dimethyl trans delta 2 PGE1 methyl ester (ONO 802) were used for the induction of abortion in early pregnancy, and this non-surgical technique was compared with suction termination performed under local anaesthesia or general anaesthesia. Ninety patients were recruited to the study and divided equally between the three groups. Complete abortion was induced in 87 per cent of the patients treated with ONO 802 suppositories, which compared favourably with 87 and 100 per cent for the patients who had suction terminations under local anaesthesia and general anaesthesia respectively. The vaginal suppositories induced uterine bleeding in all patients and the mean time of onset of lower abdominal pain was 2 hours 55 minutes. The average numbers of episodes of vomiting and diarrhoea for patients given ONO 802 suppositories were 0.9 and 0.7 respectively. Menstrual blood loss was measured objectively in all groups and no significant differences between the three methods could be found. In selected cases, ONO 802 vaginal suppositories would seem to be safe and reasonably effective for the termination of early pregnancy.

16,16-Dimethylprostaglandin E2↗
PubMed1996

Acid accumulation during end-stage bradycardia in term fetuses: how long is too long?

OBJECTIVE: To estimate the existence and degree of fetal accumulation of acid during end-stage bradycardia as reflected by the base deficit. This may set a criterion for proper intervention during labour. SETTING: Maternity unit of the Tel Aviv Medical Centre. SUBJECTS: Forty-three consecutively born term infants whose mothers were delivered by vacuum extraction were analysed: 27 because of end-stage bradycardia and 16 controls whose mothers were delivered electively because of maternal indications. MAIN OUTCOME MEASURES: Analysis of umbilical arterial cord blood for pH, PCO2 and base deficit. The base deficit was compared between the groups using the two-tailed Student's t test, and was correlated with variables of fetal heart rate monitoring using the Pearson correlation coefficient. RESULTS: The base deficit was greater in newborns who had end-stage bradycardia than in controls (11.02 vs 5.01, P < 0.0001). The duration of loss of short term variability in fetal heart rate during end-stage bradycardia correlated positively with the base deficit (r = 0.8, P < 0.0005). Conversely, the time until the loss of short term variability during end-stage bradycardia correlated negatively with the base deficit. The length and the depth of the bradycardia and their product, had a weaker correlation with the base deficit. CONCLUSIONS: End-stage bradycardia, which presumably reflects fetal hypoxia, is associated with acidaemia in the umbilical artery at birth in some fetuses. The fetuses who are predisposed to acidaemia, as reflected by an increased base deficit, are those who lost their fetal heart rate variability during end-stage bradycardia for more than 4 min or started to lose this in less than 3 min from the beginning of the end-stage bradycardia. Operative vaginal delivery should be reserved for these indications.

Acid-Base Imbalance↗
PubMed1996

A randomised comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancy.

OBJECTIVE: To assess the effectiveness and acceptability of oral misoprostol, self-administered 12 h before surgery, as a cervical priming agent prior to day case suction termination of pregnancy. DESIGN: Randomised trial comparing oral misoprostol with the local standard regimen of vaginal misoprostol. SUBJECTS: Sixty consecutive women scheduled for day case suction termination in one gynaecology unit. INTERVENTIONS: Cervical priming with misoprostol 400 mg orally, 12 h prior to surgery or 800 mg vaginally, two to four hours prior to surgery. MAIN OUTCOME MEASURES: Basal cervical dilatation, cumulative force required to dilate the cervix to 9 mm, operative blood loss and side effects (nausea, vomiting, diarrhoea, abdominal pain and vaginal bleeding). RESULTS: There were no significant differences between the oral and vaginal treatment groups in relation to basal dilatation, cumulative force to achieve 9 mm dilatation or gastrointestinal side effects. However, those in the oral group experienced more severe pain and heavier pre-operative bleeding. Two patients in the oral group experienced incomplete abortion at home after taking misoprostol and a further patient required early admission because of heavy bleeding. CONCLUSIONS: Because of the unpredictability of action of oral misoprostol, with incomplete abortion or heavy bleeding occurring prior to admission in three patients, we cannot recommend the dosage schedule evaluated here for routine clinical use.

Abortifacient Agents, Nonsteroidal↗