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PubMed1987

Thyroglobulin in cord blood. The influence of the mode of delivery and the smoking habits of the mother.

The cord thyroglobulin (Tg) concentration was estimated in 160 full-term newborns of whom 103 were delivered normally, 26 by elective Cesarean section and 31 by vacuum extraction. There was no correlation between the median cord Tg concentration and gestational age at delivery (37-43 weeks), birth weight or sex of the child or the median cord TSH concentration. The median cord Tg concentration was significantly higher in the children born by Cesarean section than in those delivered by vacuum extraction (P less than 0.001). The same tendency was found when smokers and non-smokers were compared separately. Mechanical force on the thyroid gland during labour and delivery therefore does not seem to increase the cord Tg concentration. The influence of maternal cigarette smoking on the cord Tg concentration was studied also. Forty-five mothers were smokers. The median cord Tg concentration in the children of these women was significantly higher than in the children of non-smoking mothers (130 micrograms/l vs 100 micrograms/l, P less than 0.001), whereas the median cord TSH concentration did not differ between these groups. It therefore seems possible that components of cigarette smoke, e.g. thiocyanate, may have a direct effect on the thyroid gland of the fetus.

Cesarean Section↗
PubMed1989

Surgical and nonsurgical procedures associated with hospital delivery in the United States: 1980-1987.

Data from the National Hospital Discharge Survey were used to examine changes in the rates of procedures performed on women hospitalized for delivery from 1980 to 1987 in the United States. The rate of procedures reported per 100 deliveries increased 42 percent. Much of this increase was reported from 1984 to 1987, when there may have been more complete recording of secondary procedures due to the implementation of prospective payment systems. The reported rates of cesarean sections, repair of current obstetric lacerations, artificial rupture of membranes, and vacuum extraction increased throughout the whole period from 1980 to 1987, however, and thus are less likely to have risen because of changes in reporting practices.

Delivery, Obstetric↗
PubMed1997

The influence of mode of delivery on hematologic values in the umbilical vein.

A variable white blood cell count without clinical signs of sepsis or hematological disorders is often observed in newborns. The intention of this study was to investigate the effect of mode of delivery on hematologic measurements, especially white blood cell count in the umbilical vein. 121 term newborns were investigated prospectively. They were subdivided into three groups: spontaneous births (n = 83), vacuum extraction (n = 19) and cesarean sections (n = 19). The mode of delivery influenced the leukocyte count and the precursor cells. The mean leukocyte counts after spontaneous birth (14.6 +/- 4.0 leukocytes/nl) and after vacuum extraction (16.6 +/- 7.4 leukocytes/nl) were significantly higher than after cesarean section (12.1 +/- 4.4 leukocytes/nl; p < 0.05). The precursors of leukocytes were also significantly higher in infants with vacuum extraction (1.06 +/- 0.83 cells/nl) than in spontaneously delivered infants (0.54 +/- 0.47 cells/nl). An inverse relationship between the number of leukocytes and the arterial cord blood pH was observed (p < 0.05). No significant differences were observed in the effect of mode of delivery on erythrocyte and platelet counts.

Cesarean Section↗
PubMed2003

Single-shot intrathecal sufentanil with bupivacaine in late labour--analgesic quality and obstetric outcome.

OBJECTIVES: To investigate the analgesic effect and obstetric outcome after single-shot intrathecal sufentanil with bupivacaine in late labour. STUDY DESIGN: Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 microg and bupivacaine 2 mg. Pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded. Apgar score and umbilical artery pH were noted. RESULTS: Median visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were 1.5, 0.5, 0, 1, 1.5, 2 and 3, respectively. Seventy-seven percent of the parturients scored the analgesic quality as excellent. Six parturients had hypotension. Motor block, sedation and nausea were rare. Pruritus was seen in 85% of the cases. No ceasarean section was performed. Vacuum extraction was done in six (15%) cases. Oxytocin augmentation was needed in 26 (65%) of the parturients. Fetal heart rate disturbances following the spinal block were seen in four cases. Apgar scores were high. No neonate had Apgar < 7. CONCLUSIONS: Intrathecal block with sufentanil 7.5 microg in combination with bupivacaine 2 mg is a very effective pain relief in late labour. Due to its limited duration it is important to select women in rapid progress of labour, and active obstetric management is necessary. It is also very important that the obstetrician is aware of the risk of non-reassuring fetal heart rate changes after intrathecal block.

Analgesia, Obstetrical↗
PubMed1985

Comparison of intravenous oxytocin and vaginal prostaglandin E2 gel in women with unripe cervixes and premature rupture of the membranes.

To induce cervical priming and labor, 20 nulliparous term pregnant women with premature rupture of the membranes and unfavorable cervical states were randomly given either oxytocin intravenously or 4 mg prostaglandin E2 in gel intravaginally. One of ten women receiving oxytocin had a favorable cervical state within five hours and vaginal delivery within 24 hours after the start of the infusion compared with six of ten women after prostaglandin E2 gel application. This difference is statistically significant (P less than .01). The number of instrumental deliveries was nine (four cesarean sections and five vacuum extractions) in the oxytocin-treated patients compared with only two vacuum extractions in women who received prostaglandin E2 gel. This difference is also statistically significant (P less than .01, Fischer exact test). In a subsequent open study, 4 mg prostaglandin E2 gel was applied vaginally to 17 term pregnant women of mixed parity with premature rupture of the membranes and unfavorable cervixes. In 12 women a favorable cervical state was achieved within five hours after gel application, and all these women were delivered within 24 hours. None of the women required cesarean section but two required delivery by vacuum extraction. There were no perinatal losses, but two infants in the oxytocin-treated group had Apgar scores less than 7 at five minutes. At pediatric follow-up after two and six months, all infants were normal. In both obstetric and perinatal outcome prostaglandin E2 gel thus seems to be superior to oxytocin for labor induction in term pregnant patients with premature rupture of the membranes and unfavorable cervixes.

Administration, Topical↗
PubMed1998

[Can deliveries at risk be selected at smaller delivery units?].

In order to explore the possibility of converting a delivery unit at a small hospital to a maternity home, we examined the medical records of those women who delivered by Caesarean section, forceps or vacuum extraction at Lofoten hospital during 1995. How many of these women might it have been necessary to transfer to an obstetrical department if Lofoten hospital had been a maternity home caring for low risk deliveries (primipara and multipara)? Out of a total of 271 deliveries (primiparas 98), 49 women delivered by Caesarean section (n = 35), forceps (n = 5) or vacuum extraction (n = 9). Using risk assessment, 22 women (45%) would have been selected for antenatal transfer, and 20 (41%) for intrapartum transport. For seven women no transfer would have been possible. These women would have delivered locally by vacuum extraction. Primipara versus multipara had a relative risk of 2.8 for Caesarean section or assisted vaginal delivery. It is estimated that 8-9% of the women would be selected prenatally for planned delivery at a hospital unit and that 7-8% would be transferred in labour if primiparas delivered at the maternity home. If primiparas were excluded, the proportions would be 41% and 1-2% respectively. In 1997 the delivery unit at Lofoten hospital was temporarily converted to a maternity home for a period of two years.

Birthing Centers↗
PubMed2005

[Low-risk pregnant women in an obstetric department--how do they give birth?].

BACKGROUND: The aim of the study was to investigate the obstetric outcome for low-risk pregnant women delivering in a larger community hospital with 1800 deliveries annually. The investigation was carried out before the implementation of a differentiated plan for maternity care. MATERIAL AND METHODS: From January through June 2002, 920 women delivered. 520 were retrospectively considered low risk with spontaneous start of labour (56.5% of all labours). They were selected according to defined criteria. The results of this group with 197 nulliparous (37.7%) and 323 multiparous (62.1%) women are presented. RESULTS: There were 520 live newborns. 466 infants (89.6%) had an Apgar score > or = 8 after 1 minute; 509 a score > or = 8 after 5 minutes. In this low-risk group, 10.4% instrumental deliveries were performed, 2.7% caesareans and 7.7% vacuum extractions. In nulliparous women, the instrumental delivery rate was 19.7%, among the multiparous 4.6%. A surprisingly high number of low-risk women (38.7 %) were stimulated during labour with oxytocin, 62% of the primiparous and 24% of the multiparous. The indications for this were often obscure. Among oxytocin-stimulated primiparous women, 31.2% had an instrumental delivery, against 1.3% in non-stimulated women. Epidural analgesia was given to 22.3% of all low-risk women; of these, 91.4% received oxytocin. 3.1% had a perineal tear grade > or = 3. INTERPRETATION: The assistance given to women in a larger community hospital is more geared towards progress of labour than that given in smaller hospitals and midwife-controlled maternity homes. Frequent use of oxytocin to enhance contractions and epidural analgesia probably increases the rate of instrumental deliveries. This investigation points to the necessity of developing differentiated plans for maternity care given to low-risk women delivering in larger community hospitals, in line with a policy adopted by the Norwegian parliament.

Adult↗