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Uterine rupture is a rare complication of pregnancy, occurring in 0.03% of deliveries in Denmark. This paper describes a case of asymptomatic uterine rupture in a 38-year-old woman. She was admitted with a history of excessive vaginal bleeding 14 days after a spontaneous delivery with the use of vacuum extraction. At the time of laparotomy, a complete uterine rupture was discovered and total hysterectomy was performed.
Every child with severe or moderate haemophilia A or B, born in Sweden during the period 1970-1990, was treated in the national haemophilia register, all 117 case records being surveyed for mode of delivery and perinatal complications. Of the 117 deliveries, 13 were by caesarean section and the remaining 104 vaginal. Of the 13 caesarean sections, 2 were performed because the woman was a haemophilia carrier, the remaining 11 (5 emergency, 6 elective) for other reasons. Neonatal complications were: subgaleal or cephalic haematoma (n = 12), intracranial haemorrhage (n = 4), umbilical bleeding (n = 4), haematuria (n = 1), retro-orbital bleeding (n = 1) and abnormal bleeding after surgery, injection or venepuncture (n = 28). Of the 12 infants with subgaleal/cephalic haematoma, 10 were delivered by vacuum extraction. Seven more infants were delivered by vacuum extraction and another 11 were born without abnormal bleedings after laborious (> 24 h) delivery. Of the 4 children with intracranial haemorrhage, all were sporadic cases of haemophilia, 1 was a premature birth by caesarean section in the 27th week, I was delivered by vacuum extraction and the remaining 2 vaginally. In these 4 cases there were no sequelae or only minor ones. We conclude that the risk of serious bleeding in conjunction with normal vaginal delivery is small, but that vacuum extraction should be avoided when delivering offspring of haemophilia carriers.
The relative safety and effectiveness of vacuum aspiration and the intrauterine administration of 5 mg PGF2alpha for terminating pregnancies within two weeks of a missed menstrual period were evaluated in a study where subjects were randomly assigned to procedures; 100 patients were aborted with vacuum aspiration and 100 patients were aborted with PGF2alpha. All PGF2alpha-treated patients were premedicated with meperidine, diazepam and atropine. Complications were infrequent with either of the procedures. Vomiting occurred more frequently during the PGF procedure (30.0%) than during the vaccum aspiration procedure (9.0%). The intrauterine instillation of PGF2alpha successfully terminated all pregnancies. One patient continued to be pregnant after the vacuum aspiration procedure. Based on the results of this study both study procedures appeared to be safe and effective for terminating early first trimester pregnancies.
The present study shows the frequency and severity of retinal haemorrhages in 200 newborn, of which 100 were delivered spontaneously, 51 delivered by vacuum extractor and 49 by forceps. The incidence of retinal haemorrhages was highest in the vacuum group (50%), lowest in the forceps group (16%), while the spontaneously delivered children showed an incidence of 41%. The incidence of severe retinal haemorrhages was about five times higher in the vacuum group than in both forceps and control groups. The authors propose a quantitative grading of the haemorrhages. The purpose has been to obtain a better way of relating the haemorrhages to mode of delivery and probably also to relate retinal haemorrhages to possible brain damage.
The influence of maternal height (standardized for parity and birthweight) on obstetrical outcome is studied in 1095 women giving birth in Lugarawa hospital and 3869 women delivering in Mbozi hospital, both rural hospitals in the South Western Highlands of Tanzania. Short stature was found to increase the need for augmentation of labor in primiparae, the need for operative delivery (cesarean section/symphyseotomy) in all parity groups and the need for vacuum extraction in multiparae. The absence of such an effect of height on perinatal mortality is interpreted as the result of obstetric intervention. It is concluded that maternal height, which is easy to measure, remains a useful tool to predict difficult childbirth and cephalopelvic disproportion.
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With the object of reducing the high of vacuum extraction in deliveries with lumbar epidural analgesia, we introduced "late pushing" in these deliveries in 1988. By this is understood that the parturient women is first encouraged to push when the orifice is completely dilated and the infant's head is visible at introitus. Before the "late pushing" was introduced, the frequency of vacuum extractions in deliveries with lumbar epidural analgesia was 44% of the vaginal deliveries. During the period of investigation, the frequency was 43%. Introduction of the "late pushing" thus did not result in any alteration (p greater than 0.4). Parturient women with lumbar epidural analgesia and slow progression of labour differed from the remainder of the parturient women with lumbar epidiral analgesia by significantly higher birth weights (4,000 g as compared with 3,400 g) and this may explain the increased frequency of vacuum extraction in this particular group of parturient women. The authors consider that lumbar epidural analgesia has the advantage that delivery is less painful for the mother without any simultaneous increased risk for the infant.
pH values of the blood taken intrapartally from the presenting part of fetus was analysed in 255 deliveries. The analysis comprised pH values of newborns born by Cesarean section in which pH values were determined from the blood of the umbilical cord, immediately after birth. The authors also analysed pH values in newborns born by vacuum extraction as well as in normal vaginal deliveries, and pH values were determined from the blood of the umbilical cord, immediately after birth. A part of this paper dealt with the influence of pH values on glycolysis of human fetal erythrocytes (in vitro). Decrease in pH values below 7.25 led to the slowness of the glycolysis process which was two times faster when pH values were over 7.30. The influence of pH values on intrapartal injuries of newborns was investigated in the application of vacuum extraction. These injuries were more frequent in newborns which are in acidosis, i.e. with lower values of pH blood. The authors concluded that vacuum extraction itself did not lead to injuries, but only augmented sensibility, i.e. decreased resistance of the tissue which was in acidosis were in question. They believed that vacuum extraction was a good method when applied on time in indicated cases.
Myasthenia gravis (MG) often affects women in the second and third decades of life, overlapping with the childbearing years. The course of the disease is unpredictable during pregnancy; however, worsening of symptoms occurs more likely during the first trimester and postpartum. MG can be well managed during pregnancy with relatively safe and effective therapies. Anticholinesterase drugs are the mainstay of treatment, when MG symptoms are not satisfactorily controlled, corticosteroids, azathioprine and in some cases cyclosporin A can be used. Until information is available regarding safety, mycophenolate mofetil should be discontinued before pregnancy. Pregnancy should be avoided in women treated with methotrexate because of the risk of causing typical malformations. Plasmapheresis and intravenous immunoglobulins have been successfully used in the treatment of MG crisis during pregnancy. Caesarean section is recommended only for obstetric reasons; forceps delivery and vacuum extraction are sometimes required. Epidural anesthesia is advised to reduce physical and emotional stress. MG during pregnancy can lead to serious life-threatening conditions, including respiratory insufficiency; therefore, intensive checkups by a gynaecologist and a neurologist are necessary. Women with myasthenia gravis should not be discouraged from conceiving; however, they should discuss their plan for pregnancy with their neurologist and their gynaecologist.
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OBJECTIVE: To assess the impact of mode of delivery and the occurrence of pelvic instability upon the pudendal nerve function and relate the pudendal nerve function to the occurrence of anal and urinary incontinence. METHODS: One hundred and forty-six pregnant women were examined during pregnancy and 12 weeks post partum with measurement of pudendal nerve terminal motor latency (PNTML), the difference between the two measurements was defined as delta PNTML. Anal and urinary continence status, details of delivery and the occurrence of pelvic instability were recorded prospectively. RESULTS: Pudendal nerve terminal motor latency increased from 1.7 msec in primiparae and 1.8 msec in multiparae during pregnancy to 2.0 msec (p < 0.001) and 2.1 (p < 0.001) respectively after delivery. The increase was significantly higher after the use of vacuum extraction (p < 0.04). Multivariate analysis showed that delta PNTML was associated with age, the presence of pelvic instability and the use of vacuum extraction. Whereas delta PNTML was not associated with factors such as infant's head circumference and weight, parity, cesarean section, pudendal block, epidural analgesia and second stage of labor. Only four women had anal incontinence after delivery. Twenty-five women with urinary incontinence had a significantly higher mean PNTML (2.20 msec) than 121 continent women (2.01 msec). CONCLUSION: Pudendal nerve terminal motor latency increases in both primiparous and multiparous women after delivery. In 10% of the women the increase resulted in a pathologic PNTML value > 2.4 msec. The delta PNTML was significantly associated with age, the occurrence of pelvic instability and the use of vacuum extraction. The group of women with urinary incontinence had a significant increased PNTML.
The initiation and the prevalence of breast-feeding after discharge from hospital was investigated in 370 singleton parturients and compared to the mode of delivery. Infants delivered by vacuum extraction or by caesarean section started suckling later, they were more often given formula prescription during the first 4 days, they were less often breast-fed during the night, and their mother's milk 'came in' later, but it did not affect the prevalence of breast-feeding after discharge. A sleepy infant, which was not very willing to suckle, was the most frequent nursing-problem mentioned by the mothers 4 days after delivery. Failure to start breast-feeding occurred in only 2.2% of the women, and after 6 months 52% were still breast-feeding their children.