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A critical review of selected studies of breech delivery is presented with special attention to the statistical analysis of outcome for low birth weight and term breech delivery. Analysis of the data fails to support the routine use of cesarean birth for all cases of breech delivery except for those with hyperextension of the head. The implication of these findings is discussed.
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In order to evaluate the risks specifically related to arrest disorders of labor, obstetric management and perinatal outcome were studied in 5399 births selected to exclude risks clearly not caused by abnormal labor. Management was primarily medical--among patients with arrest disorders, the cesarean rate was 13% and the midforceps rate was 4%, and among those having cesarean or midforceps delivery, 96% received prior oxytocin stimulation. Perinatal outcome was assessed by the parameters of mortality, low Apgar scores, admission to the nursery intensive care unit, and neurological abnormality. With medical management, arrest disorders were not associated with an increased risk of the adverse perinatal outcome evaluated in this study. It appears possible to reduce operative rates for arrest disorders of labor safely by more extensive use of medical management.
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Neonatal and maternal outcome in 358 midforceps and 486 cesarean deliveries was compared by retrospective analysis. Neonatal outcome was evaluated on the basis of Apgar score, cord blood gas values, admission to the neonatal intensive care unit, and birth trauma. Maternal outcome was based on intraoperative and postoperative complications, blood loss, and hospital stay. There was no increase in significant short-term neonatal morbidity in the midforceps group, while maternal morbidity was higher in the cesarean delivery group. It is concluded that, in selected cases, midforceps delivery is safe for the neonate and mother.
Cesarean delivery may be complicated by dystocia if the incision size is inadequate. A test is described that may be easily applied at cesarean section, creating greater objectivity in the determination of surgical incision size. One hundred patients were studied prospectively. Patients with incisions that passed the test had a shorter mean time of delivery and less difficult deliveries than those of patients with incisions that failed the test. We conclude that the "Allis" test is a simple way to reduce the incidence of dystocia at cesarean delivery.
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OBJECTIVE: Our purpose was to compare lactate levels with acid-base balance in the umbilical artery with respect to the prediction of pregnancy outcome. STUDY DESIGN: A prospective study of 4045 cord samples was performed. Lactate was measured with a new method that requires 5 microliters of blood and provides the result within 1 minute. RESULTS: The umbilical artery lactate concentrations were significantly elevated in instrumental deliveries (2.65 +/- 1.2 mmol/L) and in emergency cesarean sections (2.44 +/- 1.7 mmol/L) compared with spontaneous vaginal delivery (1.87 +/- 0.94 mmol/L) (p < 0.001, p < 0.001). Lactate correlated significantly to fetal pH, hemoglobin, base deficit, PCO2, and HCO3-. Lactate was comparable to pH and base deficit in sensitivity, specificity, and positive and negative predictive values in relation to morbidity and mortality. CONCLUSION: Umbilical artery lactate concentration and acid-base balance predicted perinatal outcomes with similar efficacies; however, its simplicity makes lactate analysis an interesting alternative in obstetric care.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A study is made of the obstetric performance of 2791 Maltese women in relation to their stature, the height of almost two-thirds of these mothers was 5 ft. or less. It is confirmed that today the shorter woman continues to carry a higher risk of low birth-weight, cesarean section, low Apgar score, and a bad obstetric history. It should be remembered that whereas maternal height is an index of the woman's general health and nutritional status from her childhood, yet a major role is also played by genetic factors. The obstetric significance of a particular height should be related to the patient's own genetic background. Obstetric management in relation to maternal height entails different cut-off points for different populations.
Congenital depression of the neonatal skull has had an incidence of 0.1% (1/10 000) in our newborn population during the past 8 years. These skull depressions have two pathogenetic types: deformation without fracture and fracture accompanied by depression. The cause of skull depression being the pressure exerted by the digits and fist of the newborn on his skull has not been previously reported. The treatment of choice for selected cases is nonsurgical elevation with an obstetric vacuum extractor. A CT scan should be performed prior to this treatment to rule out intracranial complications such as hemorrhage.
The neonatal survival and incidence of periventricular haemorrhage (PVH) in very-low-birthweight (VLBW) infants who present by the vertex are not influenced by the use of episiotomy. This study does not support the routine use of episiotomy for pre-term vertex deliveries.
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A case of bilateral Auriculotemporal or Frey's syndrome in childhood is unique in the World literature. The clinical presentation and management is discussed. A conservative approach is advocated but other therapeutic options are considered. The literature is reviewed, only 17 cases all unilateral are known, and from the study the probable aetiology and long term follow-up is reported.