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PubMed1989

Management of the second stage of labor: a review (Part I).

The second stage of labor is defined as that time from the completion of dilitation of the cervix to the delivery of the infant. Considerable controversy exists in the current obstetric and midwifery literature concerning the appropriate management of this stage of labor. With increased use of regional anesthesia, electronic fetal monitoring and the shift in favor of active management of labor, the second stage is often accompanied by forceful bearing-down efforts, repeated Valsalva maneuvers and an increase in the use of forceps, vacuum extraction and episiotomies. Probably the single strongest point resulting in active intervention in the second stage of labor is the rigid use of the Friedman Curve. This approach tends to insist upon a predetermined time interval and promotes early intervention. The opinions on both sides of this controversy are the topic of this review.

Female↗
PubMed1989

[Can surgeons be in charge of an obstetric department?].

At Rana sykehus there are neither obstetricians nor pediatricians. The obstetric ward is run by the surgeons. Pregnant women suspected of being at increased risks are transferred to Nordland Sentralsykehus before the expected delivery. The following data were obtained by analyzing 1,009 deliveries. 19.2% of all the deliveries needed emergency assistance by a doctor. Emergency cesarean section was performed in 6.2% of the cases, and vacuum extraction was needed in 3.2%. Elective cesarean section was done in 4.9% of all births. Emergency and elective cesarean section together made up 11.1% of the 1009 deliveries. The cesarean section rates were lower than the average number in Nordland and in the country as a whole. The perinatal death rate was lower than the average rate for the rest of the country (0.49% versus 0.8%). Infants with potential dangerous conditions were transferred for pediatric care at Nordland Sentralsykehus (3.96%). Our conclusion is that general surgeons can be responsible for an obstetric ward, when it is done voluntary, and it is approved by a responsible obstetrician. In our area there is a need for an obstetric ward, and the surgeons here have built a certain expertise in obstetrics. In difficult cases, however, the surgeons always consult the obstetricians and pediatricians at Nordland Sentralsykehus for evaluation of the patients.

Critical Care↗
PubMed1982

The use of epidural analgesia for delivery in a patient with pulmonary hypertension.

In a patients with severe pulmonary hypertension, haemodynamic observations, including cardiac output and pressure measurement in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9 to L1 combined with bilateral pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100 g girl with an Apgar score of 9 at 1 min was delivered by vacuum extraction. The patient died 9 days after the delivery because of intractable cardiac failure.

Anesthesia, Epidural↗
PubMed1996

Anal and urinary incontinence in women with obstetric anal sphincter rupture.

OBJECTIVE: To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk. DESIGN: An observational study. SETTINGS: Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark. PARTICIPANTS: Ninety-four consecutive women who had sustained an obstetric anal sphincter rupture. INTERVENTIONS: Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum. MAIN OUTCOME MEASURES: The frequency of anal and urinary incontinence and risk factors for the development of incontinence. RESULTS: Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice. CONCLUSIONS: Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.

Adolescent↗
PubMed2005

Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term.

BACKGROUND: Prolonged pregnancy is the most frequent reason for induction of labor. This study aims to determine the effects of labor induction on delivery outcome and to quantify the risks of cesarean delivery associated with labor induction in post-date pregnancies. PATIENTS AND METHODS: This retrospective case-control study included a total of 205 women who reached 42 weeks' gestation (41 weeks and 3 days) between January 2002 and April 2004 and who were scheduled for induction of labor with vaginal prostaglandins. These cases were matched for age and parity with controls in spontaneous labor beyond 41 weeks' gestation. Women with any additional medical or obstetric risk factors were excluded from the study. Maternal, neonatal and delivery outcomes were the main variables of interest. RESULTS: During the study period the data of 410 women were available for analysis. Our data revealed that the use of amniotomy (p=0.02), oxytocin (p=0.006) and epidural analgesia (p=0.001) was increased significantly in the induction group compared with the control group of women with spontaneous onset of labor beyond term. The frequency of cesarean delivery and vacuum extraction was also significantly higher in the induction group (p=0.0001). The Bishop score before induction was an important factor that affected the delivery outcome, resulting in significantly higher rates of cesarean section and vacuum extraction when the score was unfavorable (p=0.0001). A univariate regression model revealed induction per se (p=0.0001), primiparity (p= 0.0001), increased maternal age (p=0.006) and an unfavorable Bishop score (p=0.0001) as statistically significant risk factors for cesarean section. In a multivariate logistic regression model, primiparity (p=0.03), increased maternal age (p=0.02) and an unfavorable Bishop score (p=0.01) remained independent risk factors for cesarean section. High infant birth weight was also an independent risk factor (p=0.03). CONCLUSIONS: Our data suggest that women undergoing labor induction because of prolonged pregnancy should be sufficiently informed regarding the risks of a cesarean section or a vacuum extraction. Furthermore, the option of elective cesarean section should be considered, particularly in primiparous women with an unfavorable cervix, higher age, and high estimated infant birth weight.

Adolescent↗
PubMed1996

Anaesthetic management of labour in two patients with Klippel-Feil syndrome.

Two patients with Type I Klippel-Feil syndrome presented at the antenatal clinic. The first patient, who suffered from sleep apnoea, was delivered of a healthy infant by vacuum extraction. The second, who was profoundly deaf and had marked kyphoscoliosis, developed pregnancy-induced hypertension and urinary tract infection and was delivered at 38 weeks by vacuum extraction. In both cases epidural analgesia was employed to allow pain relief during labour. Anaesthetic management of Klippel-Feil syndrome is discussed and the benefits of early anaesthetic assessment and continued involvement of senior anaesthetic and obstetric staff emphasized.

Journal Article↗
PubMed1975

Clinical experience of eclampsia at the University Teaching Hospital, Lusaka. An analysis of 50 cases.

A clinical analysis of 50 cases of eclampsia for the period June 1971-June 1973 is presented. During the same period there were 32 011 deliveries--an incidence of 0,156%. Of these 50 cases, only 8 were booked. There were 40 primigravidas. The highest number of fits recorded in any one patient was 6, and 13 patients has had fits before admission. Thirty-four patients were in established labour on admission. Only 12 patients had postpartum fits. The basis of management was heavy sedation, anticonvulsant therapy and emptying of the uterus as soon as it could be achieved. Biochemical studies and urine production measurements were important supplementary measures. Twenty patients achieved vaginal delivery and 3 had symphysiotomy, assisted by vacuum extraction, low forceps and midcavity forceps, to complete the delivery. Seventeen patients were delivered by Caesarean section. The remaining 10 had vaginal delivery assisted by vacuum extraction. One mother did not survive. Of the 51 babies, 7 did not survive the neonatal period, and 4 were stillborn.

Adolescent↗
PubMed2003

Hemophilia during pregnancy.

QUESTION: A patient in my clinic, who is 10 weeks into her first pregnancy and is a known carrier of hemophilia B, is considering the advantages and disadvantages of antenatal tests and is especially worried about a vaginal delivery thatmight cause bleeding. How should I manage her pregnancy? ANSWER: Many female carriers of hemophilia were found to have lower-than-expected levels of plasma factors, which are thought to be due to X chromosome inactivation. Chorionic villous sampling is the preferred test to determine the sex of the fetus and whether a male infant is affected with hemophilia. Vaginal delivery is not contraindicated and has been proven during the last two decades to be as safe as cesarean section. Vacuum extraction should be avoided to minimize risk of intracranial hemolysis and severe cephalhematoma.

Adult↗
PubMed1998

[Anal and urinary incontinence after obstetric anal sphincter rupture].

The aim of the study was to assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence, and identify factors to predict patients at risk. In 94 consecutive women who had sustained an obstetric anal sphincter rupture, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months post partum was performed. A questionnaire regarding incontinence was sent between two to four years post partum. Forty-two percent of responders had anal incontinence, 32% had urinary and anal incontinence. Overall, 56% of the women had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies > 2.0 milliseconds and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Thirty-eight percent of the women with incontinence wanted treatment, but only a few had sought medical advice.

Adult↗
PubMedDate not supplied

[Obstetrical management in maternal tuberous sclerosis (Pringle-Bourneville syndrome)--a case report].

The rupture of visceral hamartomas in tuberous sclerosis (Pringle-Bourneville) is more likely in pregnancy because of the increased blood volume and can be followed by lifethreatening retroperitoneal hemorrhage. To avoid complications during delivery the vacuum extraction in epidural anesthesia is recommended. Preconceptional genetic counseling in this autosomal dominant disorder is obligatory.

Adult↗
PubMed1999

Raspberry leaf and its effect on labour: safety and efficacy.

The purpose of this study was to examine the safety and efficacy of raspberry leaf products consumed by a group of mothers during their pregnancy, by comparison with a group of mothers who did not. A retrospective observational design was used. Subjects were women who birth their babies at Westmead Hospital between January 1998-July 1998. The sample consisted of 108 mothers; 57 (52.8%) consumed raspberry leaf products while 51 (47.2%) were in the control group. The findings suggest that the raspberry leaf herb can be consumed by women during their pregnancy for the purpose for which it is taken, that is, to shorten labour with no identified side effects for the women or their babies. The findings also suggest ingestion of the drug might decrease the likelihood of pre and post-term gestation. An unexpected finding in this study seems to indicate that women who ingest raspberry leaf might be less likely to receive an artificial rupture of their membranes, or require a caesarean section, forceps or vacuum birth than the women in the control group.

Adolescent↗