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PubMed2006

[A midwife-led birthing unit].

BACKGROUND: The Alternative Birth Centre (ABC) is a midwife-led unit which offers low-risk women integrated, individualised antenatal, intrapartum and postpartum care. MATERIAL AND METHODS: The study included 432 women who received their care at the ABC from November 1997 until July 2000. Demographic information and details about antenatal care were recorded for all women. Information about labour, delivery and the postnatal period were recorded for the 341 women who started their labour at the ABC. RESULTS: Of the 432 women who started their care at the ABC, 265 (61.3 %) gave birth there, 100 (38 %) were primiparous while 165 (62.3 %) were multiparous. 84 (19.4 %) women were not suitable for birth at the ABC for reasons such as preterm birth, postterm pregnancies, breech presentation and preeclampsia, and were referred back to their own hospital during pregnancy. Among the 341 women that started labour at the ABC, 76 (22 %) were transferred to the obstetrical department during labour. Three reasons accounted for 88 % off all transfers during labour: failure to progress (n = 34, 44.7 %), need for continuous fetal monitoring (n = 20, 26.3 %), and the need for pharmacological pain relief (n = 13, 17.1 %). Of the 76 women transferred in labour, 42 had a spontaneous vaginal birth while 36 (44.7 %) women had an operative delivery, 14 caesarean section, 16 vacuum extraction and 1 of them forceps delivery. One baby born at the ABC had an Apgar score below 7 at 5 min. ABC is a safe alternative to standard care for low-risk women.

Adult↗
PubMed1994

Objectively measured perinatal exposure to meperidine and benzodiazepines in Finland.

We measured concentrations of meperidine and benzodiazepines in the umbilical serum of all live neonates born in Finland during a single week. Of the neonates, 31.1% were exposed to meperidine or benzodiazepines or both. One hundred twenty-one mothers of the 261 neonates exposed to meperidine were not recorded in the Finnish Medical Birth Registry as having received analgesic drugs. Infants born to primiparous mothers were more likely to be exposed. The exposures were associated with the type of delivery: vacuum extraction with a high proportion of neonates exposed to meperidine and elective caesarean section with a high proportion of neonates exposed to benzodiazepines. The exposures were influenced by the method of obstetric analgesia: epidural blockade was associated with more frequent exposure to meperidine. No significant circadian variation in exposures was detected. Validation of birth registry data is imperative before they are used for pharmacoepidemiologic studies.

Adult↗
PubMed1994

Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair.

OBJECTIVES: To determine (i) risk factors in the development of third degree obstetric tears and (ii) the success of primary sphincter repair. DESIGN: (i) Retrospective analysis of obstetric variables in 50 women who had sustained a third degree tear, compared with the remaining 8553 vaginal deliveries during the same period. (ii) Women who had sustained a third degree tear and had primary sphincter repair and control subjects were interviewed and investigated with anal endosonography, anal manometry, and pudendal nerve terminal motor latency measurements. SETTING: Antenatal clinic in teaching hospital in inner London. SUBJECTS: (i) All women (n = 8603) who delivered vaginally over a 31 month period. (ii) 34 women who sustained a third degree tear and 88 matched controls. MAIN OUTCOME MEASURES: Obstetric risk factors, defecatory symptoms, sonographic sphincter defects, and pudendal nerve damage. RESULTS: (i) Factors significantly associated with development of a third degree tear were: forceps delivery (50% v 7% in controls; P = 0.00001), primiparous delivery (85% v 43%; P = 0.00001), birth weight > 4 kg (P = 0.00002), and occipito-posterior position at delivery (P = 0.003). No third degree tear occurred during 351 vacuum extractions. Eleven of 25 (44%) women who were delivered without instruments and had a third degree tear did so despite a posterolateral episiotomy. (ii) Anal incontinence or faecal urgency was present in 16 women with tears and 11 controls (47% v 13%; P = 0.00001). Sonographic sphincter defects were identified in 29 with tears and 29 controls (85% v 33%; P = 0.00001). Every symptomatic patient had persistent combined internal and external sphincter defects, and these were associated with significantly lower anal pressures. Pudendal nerve terminal motor latency measurements were not significantly different. CONCLUSIONS: Vacuum extraction is associated with fewer third degree tears than forceps delivery. An episiotomy does not always prevent a third degree tear. Primary repair is inadequate in most women who sustain third degree tears, most having residual sphincter defects and about half experiencing anal incontinence, which is caused by persistent mechanical sphincter disruption rather than pudendal nerve damage. Attention should be directed towards preventive obstetric practice and surgical techniques of repair.

Anal Canal↗
PubMed1989

The 1984 national perinatal census: design, organization and uses for assessing obstetric services in Israel.

A nationwide perinatal census was conducted in Israel, in which medical, social, ethnic and demographic information on all births that took place in Israel within a predefined 3-month period was collected. The present study is the first to include 22,814 births that took place in all the obstetric units in Israel. The perinatal mortality rate decreased from 23.7 in 1964-68 to 13 in 1983-84. The frequency of cesarean section deliveries almost doubled over the last decade, while the use of forceps decreased significantly and the use of vacuum extraction did not change. The rate of low birthweight, however, remained constant over the last two decades. The level of hospital care has been shown to be significantly associated with perinatal mortality. The Israeli Perinatal Census may be used to provide information needed for promoting priority objectives for pregnancy and infant health, such as improving health status, identifying risk factors, increasing public and professional awareness, and improvement in services by protecting mother and fetus.

Adult↗
PubMedDate not supplied

[Perinatal care in Knin in the immediate postwar period].

By analysis of data from maternity department in Knin General Hospital for the period 1995-1999, the results of perinatal, fetal and early neonatal mortality, newborns according to birth-weight, ecclampsia frequency, cesarean sections, vacuum extractions, antenatal care and equipment of maternity department are presented. Perinatal mortality in 1997 was 7.7@1000, and in other years there were no dead infants. There was no maternal mortality. According to birth-weight, 2.7% of newborns weighted under 2500 g, 85.3% weighted between 2500-3999 g, and 12.1% weighted > or = 4000 g. Analysis by years showed no differences except for 1995, which was caused by low number of births, and increased transport to more equipped obstetric and neonatal care centres. Ecclampsia was registered in 2 cases--2.1@1000. The number of antenatal visits was continuously increasing for all those years, and in 1999 there were no unexamined pregnant women; 19.8% had 1-2 visits, and 23.9% more than 8. In 1995 there were 20.2% of pregnant women without ultrasound examination, while in 1999 there was none. In the period 1995-1999, the number of pregnant women with 2 and 3 ultrasounds increased, and 2.2-6.7% had over 4. Cesarean sections were continuously increasing and in last 5 years the rate rose from 2.6% to 5.8% of deliveries in 1999. Vacuum extractions were most frequent in 1997, 0.8%. It is emphasized that perinatal mortality decreased in the maternity department in Knin for all those years to 2.08@1000. Cardiotocographic surveillance during labour was practiced in over 90% of bearing women.

Birth Weight↗
PubMed2003

Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda.

BACKGROUND: Many perinatal deaths follow birth asphyxia that occurs in newborn babies of women who are referred on developing life-threatening obstetric complications. OBJECTIVE: To determine the antenatal and intrapartum risk factors for severe birth asphyxia among babies delivered by women admitted as emergency obstetric referrals. DESIGN: Case-control study. SETTING: Mulago hospital, the National Referral Hospital, Kampala, Uganda. SUBJECTS: Cases were newborn term babies (and their mothers) with a 5-minute Apgar score 4 or less (birth asphyxia). Controls were term newborn babies with a 5-minute Apgar score more than 4. MAIN OUTCOME MEASURES: Antepartum and intrapartum risk factors among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. The Odds ratios (OR) for various outcomes were calculated using the Statistical Assistance Software (SAS) version 6.2 (Windows), and are presented with their 95% confidence intervals (C1) and p-values. RESULTS: There was no association between socio-demographic factors and birth asphyxia. Antepartum hospitalization, antepartum or intrapartum anaemia, antepartum hemorrhage and severe pre-eclampsia/eclampsia were significantly associated with birth asphyxia; the respective ORs and 95% C1 were 1.73 (1.09-2.75), 5.65 (3.36-9.50), 2.12 (1.11-4.05) and 10.62 (2.92-38.47). Augmentation of labour with oxytocin, premature rupture of membranes, meconium staining of liquor amnii, vacuum extraction, caesarean section, low birth weight and mal-presentations were significantly associated with birth asphyxia with ORs of 5.76 (2.20-15.05), 2.23 (1.31 -3.37), 6.40 (2.76-14.82), 2.16 (1.28-3.67), 2.36 (1.07-5.20) and 6.32 (3.57-11.20) respectively. CONCLUSIONS: Early recognition of these complications among emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from birth asphyxia.

Apgar Score↗
PubMed2004

Anesthesia for obstetric patients with Gaucher disease: survey and review.

Pregnancy and delivery in patients with non-neuronopathic Gaucher disease, whether treated with enzyme replacement or untreated, are usually uncomplicated. Various factors may influence mode of delivery, vaginal or cesarean section, as well as type of anesthesia, general or regional, used during delivery. This retrospective review was intended to highlight some of the practical issues relating to obstetric anesthetic management, based on a review of the literature and experiences from a large referral clinic for Gaucher disease. In the past decade, there were 16 deliveries in 11 women in our institution. There were five normal vaginal deliveries, two vacuum extractions, one placental extraction, and eight cesarean sections. Platelet counts were 27-215 x 10(9)/L. Two spontaneous deliveries and one vacuum extraction were performed under epidural anesthesia; two other women having vaginal deliveries and one vacuum extraction were given i.v. analgesia; the fifth was given i.v. patient-controlled analgesia. The placental extraction was performed under general anesthesia. Seven of the women having cesarean deliveries received spinal anesthesia; the breech presentation required general anesthesia. There were no anesthesia-related side effects or complications, although there were some instances of post-partum bleeding irrespective of enzyme therapy. Gaucher disease affects multiple organs and can be a challenge to the anesthesiologist. Based on this survey we suggest that anesthetic management requires particular attention to hematological parameters before delivery. A multidisciplinary approach and extensive communication among obstetrician, hematologist and anesthesiologist is required to anticipate the possibility of post-partum hemorrhage, and preclude skeletal damage.

Adult↗
PubMed1991

[Alcohol in pregnancy].

In 1978, an investigation on alcohol consumption by women, before and during pregnancy, was carried out at Clinic for Gynecology and Obstetrics of the Medical Faculty in Novi Sad. This investigation studied 350 women during their stay in the hospital, after delivery and their newborns regarding birth weight, prematurity, stillbirths, operative interventions for delivery (vacuum extraction, Caesarean section, vaginal breech) and hormonal therapy during pregnancy. Ten years later, in 1988, at the same clinic, a similar investigation took place within the framework of the "Drugs and Pregnancy" project of the WHO Regional Bureau for Europe which included the study of 297 women and their newborns (average birth weight and Apgar-score study). Newborns whose mothers had been drinking before and during pregnancy had lower birth weight and length compared to the newborns whose mothers had never consumed alcohol, but these differences are not of statistical significance (X2 = 2.504; X2 = 0.922). There is no statistical significance either in the incidence of prematurity (X2 = 0.461) or in the incidence of operative interventions during delivery (X2 = 0.632). The stillbirth rate was significantly higher with a 4.3% incidence (p less than 0.05) in women consuming alcohol in contrast to the non-alcohol consumption group (0.5%). More women who had been drinking before and during pregnancy had been receiving hormonal therapy during pregnancy (X2 = 8.195 p less than 0.01). Nowadays, more women drink alcohol (60.6%) than ten years ago (48%) (X2 = 13.874 p less than 0.01). Also, nowadays more women drink during pregnancy (47.5%), than in 1978 - 27.7% (X2 = 26.979 p less than 0.01).

Alcohol Drinking↗