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[Frequency of obstetrical operations and perinatal mortality before and after admission of continuous fetal monitoring (author's transl)].

Two groups of obstetrical patients were statistically analyzed with a computer. The first group A (2339 deliveries, January 1967-June 1968) was controlled by conservative obstetrical methods, the second group B (2512 deliveries, January 1973-June 1974) was controlled by continuous monitoring of fetal heart rate and by analysis of fetal blood during labour. The results of the statistical analysis can be summarized: 1. The frequency of obstetrical operations (vacuum, obstetrical forceps, Caesarean section) increases from 12.8% (group A) to 22.5% (group B). 2. The percentage of Caesarean sections decided on for the sake of the child rose from 45.7% (group A) to 54.7% (group B). 3. Vital indications fell due to increasingly preventive obstetrics from 54.3% to 45.3%. 4. The frequency of Caesarean sections rose due to increasing indication "absolute or relative pelvic disproportion" of the mediterranean patients. 5. However the analysis of fetal blood during labour and the continuous monitoring of fetal heart rate has prevented a further increase of Caesarean sections. 6. The increasing percentage of obstetric forceps was due to our intention of preventing prolonged labour. 7. Maternal mortality after operative delivery reached 0.04% in group A and 0% in group B. 8. Perinatal mortality of children, delivered by operation, has decreased from 3.0% (group A) to 0,7% (group B). 9. The Apgar scores after operative deliveries were much better in group B (continuous fetal monitoring) than in group A (without fetal monitoring).

Apgar Score↗

[Vacuum extraction in modern obstetrics].

From 1970 to 1979 the authors analysed 1721 vacuum extractions. The method was introduced into the Department in 1965 and performed in 0.96% of cases. From 1970 to 1980 the use of VE increased from 1.97% to 4.93%. The most frequent indication for its use was the prolonged expulsion phase (49.78%). While in premature children the method was applied rarely (2.32%), in children weighing over 4000 g it was indicated in 16.44% of cases. The newborns delivered by VE proved to have increased traumatic morbidity rates (anoxia perinatalis 25.56%, haemorrhagia intracranialis 20.39%, cephalhaematoma 33.58%). The mortality of newborns delivered by VE amounted to 6.39%. There was 1.10% of unsuccessful vacuum extractions (19 parturients: in 16 forceps and in 3 cesarean section were applied). In the authors' opinion, vacuum extraction is the method of choice in the vaginal operative completion of labour: VE does not diminish the pelvic cavity or fix the position of the head of the fetus but allows the flexion of the head by natural forces. After each unsuccessful vacuum extraction it is necessary to examine its causes. The choice of the method for completing labour depends on the obstetric situation. Intracranial hemorrhages amounting to 20.39% warn the authors to reexamine the methods of their work.

Birth Injuries↗

[The place of vacuum extraction in modern obstetrics].

A clinical trial was carried out on the use of vacuum extraction for delivery of 45 women. The aim of the study is to revive again this method for it was rarely used during the last years. The authors remind of the indications and necessary condition for the use of vacuum extraction and report about complications and the course of the placental period. Parallel to this, the 45 babies born with vacuum, are followed up according birth weight, gestational age, clinical status and laboratory data by birth, resuscitation after delivery and birth trauma. By summing up the results the authors divide women (and babies) in 3 groups: deliveries with vacuum extraction (VE), VE+ forceps, Vstimmulation and forceps, Conclusions are made that VE is a useful method nowadays if classical conditions and indications are followed. The babies born by VE are in good status without serious traumas. Vstimmulation + forceps is rejected as more harmful method.

Adult↗

Review of unexplained infertility and obstetric outcome: a 10 year review.

BACKGROUND: Increased maternal and fetal risks have been reported in pregnancies following unexplained infertility. Our aims were to examine the obstetric and perinatal outcome of singleton pregnancies in couples with unexplained infertility and explore the impact of fertility treatment. METHODS: Women with unexplained infertility were identified from the Aberdeen Fertility Clinic Database. Their unit numbers were matched against the Aberdeen Maternity and Neonatal Databank (AMND) in order to extract obstetric records of those women with subsequent pregnancy outcomes. The general obstetric population served as a control group. RESULTS: Women with unexplained infertility were older [30.8 versus 27.9 years, 95% confidence interval (CI) for difference = +2.4 to +3.4] and more likely to be primiparous (59 versus 40%, 95% CI = +1.3 to +1.9). After adjusting for age and parity they had a higher incidence of pre-eclampsia, abruptio placentae, preterm labour, emergency Caesarean section and induction of labour in comparison with the general population (P < 0.05). Perinatal outcome did not differ between women with unexplained infertility and those of the general population. The multiple pregnancy rate was 5.4% higher following fertility treatment than in women who conceived spontaneously (95% CI = +2.8 to +9.7). CONCLUSIONS: Women with unexplained infertility are at higher risk of obstetric complications which persist even after adjusting for age, parity and fertility treatment. The reasons are however unclear and merit further study.

Abruptio Placentae↗

Cohort study of Silastic obstetric vacuum cup deliveries: II. Unsuccessful vacuum extraction.

In a cohort analysis of Silastic vacuum extractor deliveries, 65% were completed with the vacuum extractor alone, 24% with outlet forceps, 3% with midforceps, and 7% with cesarean section (vacuum extractor-cesarean). Control groups were formed by using the next sequential forceps delivery, spontaneous vaginal delivery, and every second cesarean section after a trial of labor. The infants were examined using a neurobehavioral scale, an encephalopathy assessment, cranial ultrasound, and indirect ophthalmoscopy. In the combined vacuum extractor and forceps delivery subgroup (vacuum extractor-forceps), all but 3% were converted from a high mid-forceps delivery to outlet forceps by the initial vacuum extractor procedure, thus eliminating many difficult midforceps deliveries. The study yielded no significant difference in maternal morbidity between vacuum extractor-forceps and forceps delivery, no difference in vaginal trauma for vacuum extractor-cesarean versus vacuum extractor delivery, and no greater hospital stay, infection rate, or need for transfusion for either vacuum extractor-forceps versus forceps delivery or vacuum extractor-cesarean versus cesarean delivery. Neonatal morbidity did not differ between successful and unsuccessful trial of vacuum extractor, except for an increased frequency of retinal hemorrhage. The frequency of scalp trauma, including cephalohematoma, did not differ between vacuum extractor-forceps and forceps delivery, or between vacuum extractor-cesarean and vacuum extractor delivery. For vacuum extractor-forceps versus forceps delivery and vacuum extractor-cesarean versus cesarean section, there were no significant differences in neurobehavioral or encephalopathy scores, or in the frequency of neonatal jaundice, facial palsy, anemia, fractures, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗