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PubMed2003

Obstetric MR pelvimetry: reference values and evaluation of inter- and intraobserver error and intraindividual variability.

PURPOSE: To establish obstetric magnetic resonance (MR) pelvimetric reference values in a large study population and stratify them according to delivery modality and to determine the intra- and interobserver error and intraindividual variability of MR pelvimetric assessment in volunteers. MATERIALS AND METHODS: MR pelvimetric data were retrospectively reviewed in 781 women (mean age, 28.9 years +/- 5.2 [SD]) clinically referred, and the data were correlated to obstetric history to derive normative values. Five observers assessed results of multiple MR pelvimetric examinations in 10 female volunteers (mean age, 34.7 years +/- 6.0; eight nullipara, two primipara) to provide data for measurement error analysis. RESULTS: All values were higher in the spontaneous vaginal delivery subgroup (n = 100) and lower in the cesarean section or vacuum extraction subgroup (n = 130; intersubgroup difference, P <.001, Mann-Whitney U test). Pelvimetric parameters in the group undergoing spontaneous vaginal delivery were as follows: obstetric conjugate, 121.7 mm +/- 8.6; interspinous distance, 112.3 mm +/- 7.9; intertuberous distance, 120.6 mm +/- 11.3; transverse diameter, 129.5 mm +/- 8.7; and sagittal outlet, 115.8 mm +/- 9.9. In the volunteer study, intraobserver, interobserver, and intraindividual reliabilities were high for the obstetric conjugate (0.94-0.96), interspinous distance (0.92-0.95), and transverse diameter (0.95-0.98) but low for intertuberous distance (0.64-0.87) and sagittal outlet (0.66-0.85). CONCLUSION: Pelvimetric dimensions are smaller in women undergoing cesarean section or vacuum extraction than they are in those delivering vaginally. The pelvimetric parameters associated with the largest measurement errors are intertuberous distance and sagittal outlet.

Adolescent↗
PubMed2005

[Perinatological aspects of mutual relationships between asthma and pregnancy].

We have researched influence of asthma on pregnancy, fetus and delivery. We have verified asthmatic pregnant women on the basis of the relevant medical documentation (N=42). Control group is made of healthy pregnant women selected under the FIGO criteria (K=100). We followed up influence of asthma on pregnancy by evaluation of 6 variables which are determinants of pregnancy quality (spontanious abortion, missed abortion, hyperemesis gravidarum, EPH gestoses, prematurity and over-carried pregnancy. Authors didn't find any statistical significance in influence of asthma on pregnancy quality although the level of pathological situations in all researched variables was about 25% higher than in control group. In over-carried pregnancy variable statistically significant low level of cases was found in researched group. Influence of asthma on fetus was monitored with the methods of clinical measurements of fetuses biophysical profile, cardiotocographic index and amnioscopy. Significantly higher participation of pathological situations was found in all three monitored variables within researched group of pregnancies (p<0.01). We have monitored influence of asthma on delivery with the methods of clinical measurement ABS pregnant-asthmatic woman, ABS of the new-born baby, body mass of new-born baby and the kind of delivery. A statistically significant fall of pp O2 (p<0.01) was found as well as declination of actual pH of pregnant-asthmatic woman toward acidosis (p<0.01) during the second delivery stage. Kind of delivery is showing statistically high level of participation of surgical termination of delivery in researched group (SC and vacuum extraction)--(p<0.001).

Adult↗
PubMed1977

[Mechanical action of obstetrical forceps on the fetal skull].

By means of schematic illustrations we demonstrate the working point of the power of labour, obstetrical forceps and vacuum extractor, The bones of the fetal skull are by sutures movable fastened together. Every extraction so will rise the intracranial pressure of the fetus, because the resistance of the birth canal tissues must be overcome. This for the extraction needed power and rising of the intracranial pressure is independent from the instrument with which the extraction is carried out. It is impossible to make a "cage" around the fetal head with the Shute forceps during extraction, to protect the fetal head from the extraction power. Another question is, that some instruments (included vacuum extractor) can limit the used power. By using forcipes with crossed lock without fixation the forces for extraction are not limited and there is a need of better operative technic. By the comparison of the forcipes from Shute, Naegele and Zweifel we can summarize, that for success is decided the indication and good operative technic and not the instrument. Every instrument for vaginal extraction has advantages and disadvantages in different obstetrical situations.

Biomechanical Phenomena↗
PubMed1989

[Obstetrical surgical interventions in teenagers younger than 16 years of age].

The age of adolescence is not biologically the proper one for performing obstetric interventions regarding both the individual psychosomatic growth of the girl and the requirements of the reproductive and dermatographic practice. The authors analyzed in the present study the incidence of major obstetric operative interventions according to the indications and age distribution on the basis of 10,182 deliveries, 271 of which belonged to teenagers. The incidence of cesarean section was 3%; forceps delivery--2.2%; vacuum extraction--0.4%; assisted breech delivery and breech extraction--2.2%; version--0.4%; inspection of the uterine cavity: manual 1.8%; instrumental--0.7%. The total incidence of major obstetric operative interventions in teenagers was 11% and compared with the operative practice in the clinic in general it was almost equal or even less. The incidence of the small obstetric repairs was significant: perineal lacerations--32.1%, cervical lacerations--2.2%, vaginal lacerations--11%. The low incidence of cesarean section (total incidence for the clinic 6-9%), contrary to expectations, was not due to fetal-pelvic disproportion in the teenagers. The aforementioned results are a part of a study, covering a three year period, designed to clarify problems on different aspects, regarding the medical and social grounds of the pregnancy and delivery in teenagers.

Adolescent↗
PubMed2006

Nationwide survey of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease in Japan.

BACKGROUND: Our purpose was to determine the outcome of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease. METHODS AND RESULTS: We surveyed by mail the Japanese national experience of pregnancy and delivery in patients known to have Kawasaki disease. The first questionnaire was returned by 154 of 207 (74%) institutions, and 16 of the 154 had knowledge of deliveries in their patients. Based on a second questionnaire, and previous Japanese case reports, we identified 46 deliveries in 30 patients from 16 institutions. The age at delivery ranged from 18 to 35 years, with a median of 27 years. Of the patients, 4 had undergone coronary arterial bypass grafting. Low-dose aspirin was given in 16 patients. The deliveries, 27 in all, had been vaginal in 20 patients, albeit that 7 required assistance by forceps or vacuum extraction under epidural anesthesia. Caesarean section had been performed in 11 patients, 3 for obstetric indications, and 1 for chest discomfort in the third trimester. Although there were no cardiac events, obstetric complications occurred in 2. CONCLUSION: The results of pregnancy and delivery were favourable. The mode of delivery should be primarily determined by obstetrical considerations, rather than the coronary arterial lesions caused by Kawasaki disease. Excessive anticoagulant therapy may not be needed for this population.

Adolescent↗