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PubMed2006

[Arterial stroke after birth trauma].

Perinatal arterial stroke is a significant cause of neurological deficit, including mental retardation, delayed motor development, epilepsy, and severe cognitive impairment. Most strokes occur in term neonates, due to thromboembolism from an intracranial or extracranial vessel associated with a risk factor such as asphyxia at birth and heart, hematological or infectious diseases. An association with instrumental delivery has not been clearly demonstrated, although several cases have been described in the literature. The incidence of stroke in the perinatal period is estimated to be 1/4000 term neonates per year. We describe three new cases of stroke in term neonates with instrumental delivery and describe the etiopathogenesis, diagnosis and outcome of this entity.

Birth Injuries↗
PubMed2003

Umbilical glutathione levels are higher after vaginal birth than after cesarean section.

Glutathione plays an important role in quenching reactive oxygen species, resulting in oxidation of glutathione, which in times of prolonged oxidative stress may be excreted from the erythrocyte. We investigated arterial and venous umbilical cord levels of glutathione in neonates born by vaginal delivery (n = 140) or cesarean section (n = 38). In a subset of neonates who were delivered vaginally maternal levels were assessed in parallel (n = 14). Median (5th-95th percentile) glutathione levels in venous and arterial umbilical samples were higher after vaginal delivery as compared to cesarean section, 2.7 (0.9-7.3) versus 2.0 (0.6-11.5; P < 0.03) and 3.5 (0.6-22.7) versus 2.3 (0.7-24.3) micromol/L (P < 0.02), respectively. Maternal glutathione levels were higher, 7.8 (4.3-10.6) micromol/L, than corresponding venous (P < 0.001) or arterial (P < 0.02) umbilical levels. These results suggest that vaginal delivery is associated with more oxidative stress than delivery by cesarean section.

Cesarean Section↗
PubMed1990

Evaluation of midforceps delivery as an alternative.

The fetal intrapartum condition as well as maternal and immediate neonatal outcome of 274 consecutive midforceps rotations (head in transverse or posterior position and below + 1 station but without reaching the perineum) were compared with 106 cesarean sections done for arrest of progress for more than two hours and cervical dilatation of at lest 7 cm. It was found that there were more nulliparous among cesarean section patients, that their fetuses weighed near 400 gm more on the average, and that their time in labor was 200 minutes longer. On the other hand, the midforceps group had a higher incidence of spontaneous labor, conduction anesthesia, and intraprtum fetal distress (37%). There were no differences in fetal outcome, other than admission to NIC and/or NIM among C-section infants. This latter group had a higher postdelivery maternal complication rate (hemorrhage and infection), as well as longer than expected hospital stay. These findings are discussed. It appears that midforceps rotation, properly indicated and executed, offers a safe alternative to C-section for delivery of the infant.

Adult↗
PubMed1969

Brow presentations.

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Cesarean Section↗
PubMed1994

Epidural analgesia in active management of labor.

OBJECTIVES: To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. STUDY DESIGN: Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed. RESULTS: Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated. CONCLUSION: The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.

Adult↗