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At least 919 records · Page 51Linked to original sources
PubMed1977

Epidural analgesia and its effects on the "normal" progress of labor.

The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.

Anesthesia, Epidural↗
PubMed1980

Breech delivery in twenty years of practice.

A major area of controversy and concern in current obstetrics practice is the management of breech presentation. Studies showing a threefold to fourfold increased morbidity rate in breeches delivered vaginally have led to striking increases in cesarean section rates. The present study comprises a review of all breech deliveries in a partnership practice through the years 1957 to 1976 to permit a follow-up period of at least 2 years. One hundred forty-one breech presentations (excluding twin pregnancies) from a total of 5,320 viable deliveries (2.6%) were managed by one of four obstetrician-gynecologists. Follow-up of the child for a period varying from 2 to 21 years was achieved in over 60% of cases. Results tend to confirm the increased hazard of vaginal delivery to the premature infant in a breech presentation but are equivocal in infants whose birth weight is greater than 2,500 gm. Implications of the study are discussed and comparison with a similar study, presented before this Society more than 25 years ago, is made.

Adolescent↗
PubMed1981

A technique to facilitate delivery of the high-floating head at cesarean section.

When cesarean section is performed before labor has lengthened and attenuated the lower uterine segment one may encounter considerable difficulty delivering the floating fetal head. The result is often either traumatic or deliberate extension of the uterine incision and undue delay in delivering the infant. This report describes a practical technique to facilitate delivery of the infant in this difficult circumstance.

Cesarean Section↗
PubMed1983

Randomized management of the nonfrank breech presentation at term: a preliminary report.

Cesarean section has become the standard management used by many clinicians for breech presentation in labor. Proof of the superiority of routine cesarean section has been largely circumstantial. Concern over rising cesarean section rates has led to renewed interest in possible alternatives. Protocols have been developed to select which patients may be allowed a trial of labor with frank breech presentation at term. We undertook a prospective clinical trial comparing elective cesarean section with a selective management protocol for the nonfrank breech presentation at term. One hundred five patients with nonfrank breech presentations at term in labor were studied. Seventy (67%) were randomized to a trial of labor and 35 (33%) to elective cesarean section. Of the patients allowed a trial of labor, 31 (44%) were delivered vaginally, and 39 (56%) required cesarean section. The largest single cause of a "failed" trial of labor was inadequate pelvic dimensions on x-ray pelvimetry (23 patients, 59%). Neonatal morbidity assessed by Apgar scores, cord gases, birth injury, and hospital stay was not different for those delivered vaginally or by cesarean section. Maternal morbidity in terms of febrile morbidity, blood transfusion, wound infections, and hospital stay was significantly greater among women delivered by cesarean section. Two of three neonatal deaths occurred in infants with major congenital anomalies. The third infant, apparently normal, died after vaginal delivery. Extensive evaluation suggests the death was attributable to inadequate resuscitation. We conclude that the use of a selective management protocol under controlled conditions is a reasonable alternative to elective cesarean section. Approximately one half of patients allowed a trial of labor may be expected to deliver vaginally with neonatal morbidity comparable to that seen with cesarean section.

Adult↗
PubMed1983

Midforceps delivery: a critical review.

A survey of results of midforceps delivery in mother and fetus was carried out, reviewing the most relevant publications of the past several years. Many discrepancies have been found from definition of what is (or should be) considered midforceps delivery to methods of gathering the material for analysis and the statistical evaluations. Specific study of some of these results was done which revealed possible flaws in the conclusions reached by the authors. Clearly maternal mortality is no longer a justifiable aspect to be studied. However, maternal morbidity should be considered and compared to that associated with vaginal and/or cesarean section deliveries. Likewise perinatal mortality and morbidity should be the standard of study and, in particular, long-term follow-up of infants delivered by the various methods. Until those observations are made from reliable data of comparable populations, it is probably not justified to condemn midforceps deliveries well conducted and judiciously indicated.

Anesthesia, Conduction↗
PubMed1986

Midforceps deliveries: long-term outcome of infants.

Infants delivered by midforceps between 1976 and 1982 were evaluated for evidence of developmental delay or neurological deficit by chart review. The 110 infants who were followed for at least 2 years were compared to a matched group of infants delivered by cesarean section. The cesarean section group was matched for the immediate indication for delivery (dystocia or fetal distress), birth weight, gestational age, sex, and race. There was no significant difference in abnormal outcomes in the two groups.

Birth Injuries↗