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PubMed1991

Influence of mode of delivery on fetal pituitary-thyroid axis.

We measured the cord serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) in 922 neonates delivered by mothers who had no thyroid disorders. The T4 and T3 levels increased progressively from the 27th to the 40th week of gestation. However, the TSH levels varied widely and had no correlation with gestational age, because they were affected by the mode of delivery. The mean cord serum TSH level in neonates delivered by vacuum extraction was 16.3 +/- 10.0 microU/ml (n = 30), which was significantly higher than the level following normal vaginal delivery (9.5 +/- 6.0 microU/ml, n = 622) (p less than 0.005). The mean cord serum TSH level following elective caesarean section was 6.5 +/- 3.1 microU/ml (n = 79), and this was significantly lower than after normal vaginal delivery (p less than 0.005). TSH levels in high-risk neonates were significantly higher than in neonates without risk factors. A significant positive correlation was found between the duration of the second stage of labor and the cord serum TSH level (r = 0.45, n = 412, p less than 0.01). However, there was no correlation between the cord serum TSH level and the congenital hypothyroidism screening TSH level (r = 0.01, n = 468). We conclude that the cord serum TSH level reflects delivery stress and that an elevated level does not influence the congenital hypothyroidism screening TSH test in which blood is obtained at five days of life.

Adult↗
PubMed2004

[Delivery and perinatal aspects of pregnant women with pre-eclampsia-eclampsia].

UNLABELLED: Hypertension is the most important cause of disease in the expectant mother and the fetus, and it unfavorably affects the perinatal morbidity and mortality. AIM: To determine the method of delivery of a pregnant women with Praeeclampsia-Eclampsia (PE-E) depending upon the severity, continuity and term of appearance of hypertensive disease during pregnancy and its impact on perinatal morbidity and mortality. MATERIAL AND METHODS: The study covers a two year period (2002-2003), during which 84 pregnant women are treated and deliver with PE-E in the Ist and IInd Obstetrics clinics. Of them 64 (76.20%) are with mild form of PE, 10 (11.90%) with mid severe form and 10 (11.90%) severe form of which 3 had Eclampsia. The pregnancies were followed using echography and cardiotocographic monitoring. RESULTS AND DISCUSSIONS: With the severe forms of PE-E the disease started between 25-30 gestational weeks (60%), while with the mid severe the appearance was between 31-36 g.w. (50%). Persistence of PE > 4 g.w. was observed with severe PE, whereas in mild forms continuity of < 3 g.w. (73.44%) prevailed with its onset after 37 g.w. (57.81%). Normal delivery was attained with 41 pregnancies (48.81%), Caesarean section (CS) with 40 (47.62%), vacuum extraction with 1 (81.19%) and 2 (2.38%) had incomplete aborts. Frequency of CS with the severe forms of PE-E is 80%, with mid severe 50%, and with the mild forms is 42.19%. The most frequent indication of CS is fetal distress--11 (27.50%) and complicated obstetric anamnesis--9 (22.50%). With severe PE-E the most frequent indication is aggravation of symptoms and its non responsiveness to treatment. Born dead are 3 fetuses with severe retardation and body weight < 800 gm. Early gestational age hasn't given us the reason for premature delivery. Death of 1 child, born by CS with 750 gm weight is recorded. The higher rate of CS (3 times more than the median for the clinic--15.16%) can be explained to a degree by the fact that operative delivery by CS in pregnancies with PE-E reduces complications and has an aim to prevent complications to the fetus as well as the mother.

Bulgaria↗
PubMed1977

[Epidural anaesthesia in obstetrics (author's transl)].

Review of 1400 epidural anaesthesias during labour and delivery. The single shot method resulted in complete analgesia in 83.8% of the cases. There were 2.8% failures. With longer duration of albour 13.4% of the epidural anaesthesias had to be repeated. Epidural anaesthesia was tolerated well by the women in labour. Hypotension occurred in 21.6% of the cases and was corrected by intravenous infusion and positioning of the patient on the side. No adverse effects on the fetus were found. The duration of labour and delivery was not prolonged. The caesarean section rate was not increased by epidural anaesthesia. Because of the more difficult bearing down reflux during the second stage of labour, the incidence of vacuum extractions was increased by 1 to 3%. The incidence of forceps deliveries remained stable. There was no significant increase of abnormal vertex positions. Postpartum headaches because of decompression by loss of cerebrospinal fluid was seen in 2.2% of the cases. The headaches subsided on complete bed rest. One case of total spinal anesthesia with respiratory arrest is reported which necessitated immediate intubation. Another dangerous complication was noted in a Para 2 who suffered a complete uterine rupture below the level of the epidural anesthesia without any clinical signs and symptoms. Therefore continual internal fetal monitoring is considered to be essential in all cases with epidural anaesthesias. Previous caesarean sections or uterine operations are no contra-indications to epidural anaesthesia.

Anesthesia, Epidural↗
PubMed1991

Foetal and maternal outcome of vacuum extraction.

In a prospective study, 167 vacuum extractions (VE) performed at the Kenyatta National Hospital, Nairobi, formed 6.3% of the total deliveries. Most patients were young and of low parity. There were no maternal deaths. The overall maternal morbidity rate was 22% and were mostly minor. Post partum haemorrhage was the most common maternal complication. There were 5 failed VEs. Perinatal morbidity and mortality rates were 16.2% and 4.8% respectively. Intrauterine asphyxia was the commonest cause of death. Several complications could have been avoided by more stringent use of the instrument. The place of VE in a busy obstetric unit is discussed.

Adolescent↗
PubMed2001

Septic shock resulting in death after operative delivery.

BACKGROUND: We report a young woman who developed septic shock after operative delivery in the 32nd week of pregnancy. Clinical features, treatment modalities and prognosis of this high-mortality-rate disorder are presented and discussed. CASE: A 24-year-old woman, gravida 1, para 1, was referred to our clinic in a confused state and immediately admitted to our emergency unit. She apparently had eclampsia antenatally. Termination of pregnancy with induction of labor and vacuum extraction had been employed in gestational week 32 of pregnancy. One day after delivery, her clinical and laboratory parameters worsened, so she was referred to our clinic. After a thorough physical examination and laboratory evaluation, the patient was diagnosed as having sepsis and disseminated intravascular coagulation. After blood and urine cultures were taken, aggressive management included volume repletion, antibiotics and positive inotropic therapy. Because she had persistent fever and unimproved laboratory values despite these therapies, the uterus and ovaries were thought to be the source of sepsis, and total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Neither clinical nor laboratory parameters improved, and the patient died 28 days after delivery as a result of respiratory failure. CONCLUSION: It is our purpose to emphasize that a rapid and appropriate decision for surgery may prevent the maternal mortality in obstetric septic shock patients. Successful management depends on early identification and aggressive treatment.

Adult↗
PubMed1999

Obstetric complications and the risk of schizophrenia: a longitudinal study of a national birth cohort.

BACKGROUND: Numerous epidemiological studies found an increased risk of schizophrenia among persons exposed to various obstetric complications. The underlying mechanisms are unknown. OBJECTIVE: To study specific risk factors, as well as sets of risk factors, representing 3 different etiologic mechanisms: (1) malnutrition during fetal life; (2) extreme prematurity; and (3) hypoxia or ischemia. METHODS: In this longitudinal cohort study, information in the National Birth Register was linked to the National Inpatient Register. We followed up 507516 children born between 1973 and 1977 with regard to a diagnosis of schizophrenia between 1987 and 1995 (238 cases). By record linkage, we also had access to data on psychiatric illness in the mother. Occurrence of schizophrenia was measured by the Mantel-Haenszel test and logistic regression. RESULTS: A number of specific risk factors were associated with an increased risk of schizophrenia. The relative risk (95% confidence interval) for preeclampsia was 2.5 (1.4-4.5); vacuum extraction, 1.7 (1.1-2.6); and malformations, 2.4 (1.2-5.1). In logistic regression models, we found that indicators of all 3 etiologic mechanisms were associated with increased point estimates of schizophrenia, although at lower risk levels. Preeclampsia, an indicator of fetal malnutrition, was the only risk factor with statistically significant increased risk after control for all potentially confounding factors. CONCLUSION: This study supports the theory of an association between obstetric complications and schizophrenia. Although preeclampsia was the strongest individual risk factor, there was evidence of increased risk associated with all 3 etiologic mechanisms.

Adult↗
PubMed2006

Risk factors for hypoxic-ischemic encephalopathy in asphyxiated newborn infants.

OBJECTIVE: To determine the risk factors for hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborn infants. MATERIAL AND METHOD: A retrospective study of 17,706 newborns, who were admitted to the Neonatal Unit of King Chulalongkorn Memorial Hospital, from July 1999 till the end of December 2000. 84 infants with perinatal asphyxia were enrolled in the present study. All of the possible risk factors that might have contributed to asphyxia were identified and recorded HIE was diagnosed based on the Modified Sarnat-Sarnat Score for the diagnosis of neonatal encephalopathy. The clinical data of the HIE group were compared with those of the HIE negative group. The categorical data were analyzed for statistical significance (p < 0.05) by Chi-square test or Fisher exact test, or Student t-test. The odds ratio and 95% CI were calculated for those with statistical significance. Stepwise multiple logistic regression analysis used to determine the independent factors that may predispose an infant to HIE. RESULTS: Inappropriate antenatal care (OR 9.4; 95%CI: 2.6-35.4), post-term gestation (OR 7.4; 95%CI: 1.4-34.8), vacuum extraction (OR 5.4; 95%CI: 1.1-26.8), male (OR 4.8; 95%CI: 1.3-19.1), prolapsed cord (p = 0.01) and 1 and 5-minute Apgar scores, (p < 0.0001) were significant risk factors for HIE. However, by multiple regression analysis, only a 5-minute Apgar score was significantly associated with HIE (p = 0.001). CONCLUSION: Sophisticated or expensive equipment is not necessary for the treatment of HIE patient. HIE depends mainly on adequate and effective supportive strategy. The delivery of high risk pregnancies, under obstetric facilities and with appropriate intervention and with good neonatal resuscitation, may prevent the perinatal asphyxia and thereby minimize the occurring of HIE.

Apgar Score↗
PubMed2005

Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study.

OBJECTIVE: The study was aimed to identify obstetric risk factors for early postpartum hemorrhage (PPH) in singleton gestations and to evaluate pregnancy outcome. STUDY DESIGN: A comparison between consecutive singleton deliveries with and without early PPH was performed. Deliveries occurred during the years 1988-2002 in a tertiary medical center. A multivariate logistic regression model was constructed in order to define independent risk factors for PPH. RESULTS: Postpartum hemorrhage complicated 0.4% (n = 666) of all deliveries enrolled in the study (n = 154 311). Significant risk factors for PPH, identified using a multivariable analysis, were: retained placenta (OR 3.5, 95%CI 2.1-5.8), failure to progress during the second stage of labor (OR 3.4, 95%CI 2.4-4.7), placenta accreta (OR 3.3, 95%CI 1.7-6.4), lacerations (OR 2.4, 95%CI 2.0-2.8), instrumental delivery (OR 2.3, 95%CI 1.6-3.4), large for gestational age (LGA) newborn (OR 1.9, 95%CI 1.6-2.4), hypertensive disorders (OR 1.7, 95%CI 1.2-2.1), induction of labor (OR 1.4, 95%CI 1.1-1.7) and augmentation of labor with oxytocin (OR 1.4, 95%CI 1.2-1.7). Women were assigned into three different groups according to the assessed severity of PPH, assuming that the severe cases were handled by revision of the birth canal under anesthesia, and the most severe cases required in addition treatment with blood products. A significant linear association was found between the severity of bleeding and the following factors: vacuum extraction, oxytocin augmentation, hypertensive disorders as well as perinatal mortality, uterine rupture, peripartum hysterectomy and uterine or internal iliac artery ligation (p < 0.001 for all variables). CONCLUSION: Hypertensive disorder, failure to progress during the second stage of labor, oxytocin augmentation, vacuum extraction and LGA were found to be major risk factors for severe PPH. Special attention should be given after birth to hypertensive patients, and to patients who underwent induction of labor or instrumental delivery, as well as to those delivering LGA newborns.

Arteries↗
PubMed1993

[Induced labor: conditions for success and causes of failure. A prospective study of 162 cases].

The authors report the results of a prospective study of 162 cases of induced labour collected between 30 October 1990 and 31 December 1991 in the maternity unit of the Yaounde teaching hospital group. There were 1,640 deliveries during this period. Premature rupture of the membranes in 72 cases (44.4 per cent) and postmaturity in 42 cases (27.2 per cent) were the chief indications for the induction of labour in this study. There were 138 cases (85.2 per cent) of spontaneous delivery, 20 cases (12.3 per cent) of cesarean section and 4 cases (2.5 per cent) of vacuum extraction. Failure of induction occurred in 16 cases (9.8 per cent). Repeat induction of labour after a rest period led to spontaneous delivery in 6 cases. There were 6 fetal deaths, i.e. a perinatal mortality of 3.7 per cent. Postmaturity (3 cases) and premature rupture of the membranes (2 cases) were the risk factors in these six fetal deaths. Analysis of cases of failed induction and of fetal deaths in this study leads the authors to conclude that ripening of the cervix is an essential parameter for success of the artificial induction of labour. Premature rupture of the membranes, and postmaturity associated with an unripe cervix are unfavourable risk factors for the induction of labour and are potential indications for preventive cesarean section in order to avoid fetal death.

Cesarean Section↗
PubMed2001

Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women.

OBJECTIVE: Our goal was to evaluate the relationship between obstetric perineal trauma and postpartum sexual functioning. STUDY DESIGN: Our study was carried out with a retrospective cohort design in 3 groups of primiparous women after vaginal birth: Group 1 (n = 211) had an intact perineum or first-degree perineal tear; group 2 (n = 336) had second-degree perineal trauma; group 3 (n = 68) had third- or fourth-degree perineal trauma. These sample sizes reflect a 70% response rate. Outcomes were time to resuming sexual intercourse, dyspareunia, sexual satisfaction, sexual sensation, and likelihood of achieving orgasm. RESULTS: At 6 months post partum about one quarter of all primiparous women reported lessened sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm, as compared with these parameters before they gave birth. At 3 and 6 months post partum 41% and 22%, respectively, reported dyspareunia. Relative to women with an intact perineum, women with second-degree perineal trauma were 80% more likely (95% confidence interval, 1.2--2.8) and those with third- or fourth-degree perineal trauma were 270% more likely (95% confidence interval, 1.7--7.7) to report dyspareunia at 3 months post partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3--4.8), and women who breast-fed were > or = 4 times as likely to report dyspareunia as those who did not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7--7.0). Episiotomy conferred the same profile of sexual outcomes as did spontaneous perineal lacerations. CONCLUSIONS: Women whose infants were delivered over an intact perineum reported the best outcomes overall, whereas perineal trauma and the use of obstetric instrumentation were factors related to the frequency or severity of postpartum dyspareunia, indicating that it is important to minimize the extent of perineal damage incurred during childbirth.

Adult↗