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PubMed2000

Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth.

OBJECTIVE: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. DESIGN: Randomised controlled trial. SETTING: Large maternity teaching hospital in Melbourne, Australia. PARTICIPANTS: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). MAIN OUTCOME MEASURES: Maternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. RESULTS: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84). CONCLUSIONS: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded.

Adult↗
PubMed1996

The assessment of bladder neck position and mobility in continent nullipara, mulitpara, forceps-delivered and incontinent women using perineal ultrasound: a future office procedure?

The purpose of this study was to assess the effects of spontaneous and instrumented deliveries, the baby's birthweight, the presence of stress incontinence and the woman's age and weight on bladder neck (BN) position and mobility using perineosonography, a simple non-invasive method, and to compare these results with those from continent nulliparous controls. Two hundred and fourteen women, including 74 nullipara, 29 para-1, 64 para-2 and 3, 16 with previous forceps deliveries and 32 with stress incontinence, underwent perineosonography with measurements of BN position and backwards/downwards displacement of BN using a two-axis calculation system. Results showed that bladder neck position undergoes a significantly backwards and downwards displacement on assuming an upright position. When compared with nulliparous controls, the bladder neck position at rest was the same in all groups of parous women in the supine/standing positions, but lower in patients having undergone forceps delivery (standing position) and in stress incontinent patients (both supine and standing); the bladder neck position during Valsalva was significantly lower in all groups of patients in the standing position, but the only significant difference in the supine position was seen in stress incontinent patients; the extent of bladder neck displacement was not significantly different between the groups, except in stress incontinent patients. A strong correlation (r = 0.66) was found between the relative importance of backwards and downwards displacement, but no correlation was found between bladder neck displacement and baby's birth-weight or patient's weight. It was concluded that compared to nulliparous continent patients, normal and instrumented delivery induces no modifications of BN position at rest, but is responsible for a lower bladder neck position during Valsalva in the standing position only. The extent of BN displacement is virtually the same in all groups of patients in both positions, except for stress incontinent patients, who have a significantly lower and more mobile bladder neck, the values of which overlap to a great extent (sensitivity of 78%/75% for a displacement > 14 mm) within those seen in continent nulliparous women. The correlation between the importance of backwards and downwards displacement is strong, making superfluous a two-dimensional coordinate system for routine BN position/mobility assessment.

Age Factors↗
PubMed1997

Birth trauma causing nasal vestibular stenosis.

Nasal vestibular stenosis is caused by a disruption of the nasal vestibular lining with secondary proliferation of granulation and fibrous tissue. It is most commonly the result of significant nasal trauma of foreign body reaction. In the pediatric population, it is exceedingly rare, with only a few cases reported in the literature. We report the first case, to our knowledge, of complete stenosis caused by traumatic vaginal delivery. This case demonstrates the profound effect nasal vestibular stenosis can have on the developing nose. Correction can be difficult because of the tendency of wound contracture and recurrence. A new approach is presented, using a hard palate mucosal graft. This graft is tough, resilient, and easily harvested. Its ability to resist contracture obviates the need for postoperative stenting, which is especially useful in the pediatric population.

Birth Injuries↗
PubMed1987

Vaginosonographical determination of the true conjugate and the transverse diameter of the pelvic inlet.

In suspected cases of cephalopelvic disproportion pelvic measurement and the estimation of the fetal weight can be essential for the management of labor. We measured the true conjugata and the widest transverse diameter of the pelvic inlet with a new vaginal scanner. The biparietal diameter (BPD) was measured with a real-time sector scanner. The results of vaginosonographical measurement were compared and showed good correlation with both conventional radiological measurement and measurements obtained by a compound scanner. Vaginosonographical measurement which causes no pain, is quick and also allows measurement of the transverse diameter of the pelvis, might become a routine method in all suspected cases of cephalopelvic disproportion.

Birth Weight↗
PubMed1987

Obstetrical anaesthesia at Winnipeg Women's Hospital 1975-83: anaesthetic techniques and complications.

The obstetrical anaesthesia experience of the Winnipeg Women's Hospital from 1975 to 1983 was reviewed (n = 22,925 infants). Use of narcotics in labour for analgesia decreased from 38.7 to 18.3 per cent of the deliveries. For analgesia during spontaneous vaginal deliveries, epidural anaesthesia increased from 6.0 to 24.0 per cent, inhalational analgesia decreased from 53.7 to 3.2 per cent while "no anaesthetic intervention" rose from 40.3 to 72.8 per cent. Use of epidural anaesthesia for Caesarean section increased from 58.7 to 82.6 per cent. The most common acute complications of anaesthesia were hypotension and inadvertent dural puncture during epidural catheterization. The incidence of hypotension decreased from 28.3 to 17.4 per cent during the nine-year period. Dural puncture decreased from 4.7 to 1.1 per cent of all epidural administrations. Postpartum complaints (that were thought to be related to anaesthesia) were mainly headache, back pain and sore throat. The incidence of these complaints also decreased over the study period.

Analgesics, Opioid↗
PubMed2003

Incidence and treatment of urinary retention postpartum.

The aim of this clinical study was to examine the incidence of postpartum urinary retention, to investigate the relationship between different obstetric parameters, and to find out whether our proposed treatment program fulfilled our needs. The incidence of urinary retention postpartum was 0.7%. The incidence of instrumental delivery, sphincter rupture, and larger lacerations of the perineum was significantly increased in the group with urinary retention. Our program for detecting and treating patients with postpartum urinary retention seemed to work efficiently.

Adult↗