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PubMed1990

[Obstetric analgesia using nitralgin inhalation and lumbal peridural anesthesia (a model for obstetric analgesia)].

Authors report the systems of anesthesia used at their ward for delivery in the last eight years. Nitralgin inhalation is used since 1981, lumbar peridural anesthesia is used since 1983. Of 13,458 deliveries in case of 3893 parturiants Nitralgin analgesia was used, while LEDA was used for 2300 parturients. By means of Nitralgin inhalation system it could be assured in the delivery room to apply the pain relief gas mixture (Nitralgin) simultaneously for several parturients. With direction of anesthesiologists employed for the ward the LEDA was attained by gynecologists knowing the use and application of general anesthesia. Thus the continuous application of both procedures can be ensured in 24 hours a day. In our study the frequency of vacuum extraction (0.26 p. c.) and that of Cesarean section (12.81 p. c.) did not increase. With application of these methods it could be achieved that 60 p. c. of vaginal deliveries are performed with anesthesia. Authors propose their system for wider application since in the same ward more and more parturients can be applied anesthesia for pain relief at vaginal delivery.

Adult↗
PubMed2005

Obesity-related complications in Danish single cephalic term pregnancies.

OBJECTIVE: Our objective was to investigate the relationship between prepregnancy and obstetric body mass index (BMI) as well as fetal complications in a large, unselected cohort of Danish women with single cephalic pregnancies. METHODS: A cohort of 8,092 women from the Copenhagen First Trimester Study with a registered prepregnancy BMI and a single cephalic term delivery were stratified into 3 BMI groups: normal weight (BMI < 25 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI >/= 30 kg/m(2)). The effects of BMI and parity on the outcome were analyzed using multivariate logistic regression analyses. RESULTS: Overweight women had an odds ratio (OR) of 3.4 for diabetes, 1.9 for hypertension, 1.7 for preeclampsia, and 1.5 for cesarean delivery. The corresponding figures for obese women were 15.3, 4.8, 2.7, and 1.7, respectively. No relationship was found between BMI and vacuum extraction. Obese women had an increased risk of delivering macrosomic but also low birth weight children. No differences existed among the 3 weight groups with regard to neonatal morbidity estimated by Apgar score, umbilical cord pH, or admittance to a neonatal intensive care unit. Nulliparous women had an increased incidence of preeclampsia (OR 2.8), hypertension (OR 1.9), emergency cesarean delivery (OR 3.4), vacuum extraction (OR 5.6), and perineal rupture (OR 1.7) but a lower frequency of elective cesarean delivery (OR 0.25). CONCLUSION: The rate of complications during pregnancy and delivery increases with an increasing prepregnancy BMI in women with single cephalic term pregnancies, particularly in nulliparous women.

Birth Weight↗
PubMed1998

Familial occurrence of dystocia.

OBJECTIVE: A cohort study was conducted to determine the risk of dystocia for women whose mothers, sisters, or twin sisters had dystocia during childbirth. STUDY DESIGN: A linked database was constructed between 2 separate Swedish birth registries. Obstetric data on mothers giving birth to daughters during the period 1955 to 1972 were studied. Among these daughters, sister-couples and twins were identified. The daughters subsequently became mothers during 1973 and 1990 and obstetric data on the first deliveries were also studied. RESULTS: If a mother had dystocia when delivering her eldest daughter, this daughter had an increased risk of dystocia during her own first childbirth (odds ratio 1.7, 95% confidence interval 1.2 to 2.4). If the mother had an assisted instrumental delivery (vacuum extraction, forceps, or cesarean section) because of dystocia, there was a higher risk for her daughter to have an instrumental delivery because of dystocia (odds ratio 1.8, 95% confidence interval 1.0 to 3.1). Among primiparous sisters the risk of an instrumental delivery because of dystocia in a younger sister was more than tripled (odds ratio 3.5, 95% confidence interval 2.1 to 5.8) if her elder sister had a dystocic labor requiring instrumental intervention. The risk among twins increased more than 20-fold (odds ratio 24.0, 95% confidence interval 1.5 to 794.5) if 1 twin sister had dystocia during her first childbirth. CONCLUSION: Dystocia has a familial occurrence, suggesting a possible genetic factor explaining inefficient uterine action.

Cross-Sectional Studies↗
PubMed1988

Case control study of hypospadias, based on registry information.

With the aid of data in the Swedish Medical Birth Registry for infants with hypospadias and controls, a number of variables were compared. Records of infants born in 1982-1983 (188 cases and 376 matched controls) contained information on involuntary infertility, previous spontaneous and induced abortions, use of oral contraceptives or a remaining IUD at conception, smoking in early pregnancy, occupation in early pregnancy, family situation, and diagnoses given during pregnancy and at delivery, including information on caesarean section and vacuum extraction. Among all variables studied, only one group of statistically significant differences appeared: women whose sons had hypospadias more often than controls had a diagnosis of weak contractions, a higher rate of induced deliveries, and also a higher rate of caesarean sections. The finding of a higher caesarean section rate in infants with hypospadias was verified in a separate study of 1,736 hypospadic infants delivered in 1973-1981 and compared with all births in Sweden during that period. No difference in the rate of vacuum extractions was seen. This finding is interpreted as a result of an abnormality of the fetal-placental-maternal organism interaction, perhaps also disturbing the early pregnancy and increasing the risk for hypospadias.

Contraception Behavior↗
PubMed1986

[Pregnancy, labor and the puerperium in paraplegic patients].

Due to better care and better knowledge pregnancies in paraplegic patients nowadays have a good prognosis. We report on 16 deliveries in 13 paraplegic or tetraplegic patients. To minimise the danger of possible further damage it is important to know about the special problems associated with pregnancies in paraplegic mothers. It is particularly important to know about the elevated risk of premature labour and the risk of autonomic hyperreflexia in lesions above D7. To prevent urogenital infections, patients should try to keep the genital region clean and try to empty the bladder as completely as possible. Intermittent catheterisation might be necessary. One should try to prevent decubital ulcers, and therefore an eventual anaemia (below 80%) should be corrected by transfusions. The patients should be instructed how uterine contractions can be palpated manually because sometimes perception of contractions in other ways is not possible. Repeated examinations of the cervix also help to prevent premature birth. Hospitalisation of the mother two to three weeks before the expected date of birth is suggested. If the lesion is higher than D7, symptoms of autonomic hyperreflexia (bradycardia and rise of blood pressure with the risk of cerebral haemorrhagia) are almost always present when labour starts. To prevent this possibly life-threatening complication, early application of epidural anaesthesia is suggested. There is no contraindication to spontaneous delivery. Vacuum extraction or forceps are necessary more frequently. In the post-partal period, prophylaxis of decubital ulcers is important. Breast feeding is not influenced.

Adult↗
PubMed2006

Identification and management of women with inherited bleeding disorders: a survey of obstetricians and gynaecologists in the United Kingdom.

A mail survey of members and fellows of Royal College of Obstetricians and Gynaecologists was carried out to determine current practices of obstetricians and gynaecologists in the United Kingdom in the management of women with inherited bleeding disorders. In total, 3929 questionnaires were sent, 707 returned and analysis was limited to 545 valid questionnaires. In the past 5 years, 91% have managed women with inherited bleeding disorders. The majority (83%) considered inherited bleeding disorders to be under diagnosed in obstetrics and gynaecology. More than 80% considered the prevalence of von Willebrand's disease (VWD) to be <0.2% in the general population and <1% in women with menorrhagia and no gynaecological pathology, although the reported prevalence is 1% and 5-25% respectively. Twelve percent of the respondents would arrange testing for VWD when reviewing an 18-year-old with menorrhagia and no pelvic pathology, while only 2% would do the same for a 35-year-old with the same presentation. Twenty-one percent thought elective caesarean section is indicated in all fetuses known to be at risk of being affected by haemophilia. Eighty-four percent considered vacuum extraction unsafe in these cases, but 76% would consider the use of low forceps. In conclusion, obstetricians and gynaecologists underestimate inherited bleeding disorders as an underlying cause for menorrhagia. Increased awareness and management guidelines are essential in minimizing haemorrhagic complications and improving quality of care of these women.

Adolescent↗
PubMedDate not supplied

Perinatal outcomes: a comparison between family physicians and obstetricians.

BACKGROUND: This retrospective study compared obstetrician and family physician patient population demographics, obstetric outcomes, delivery methods, and medical risk factors. METHODS: Obstetricians and family practice faculty and residents provided delivery services at an urban community hospital. A retrospective case study of all deliveries by obstetrician-gynecologists and family physicians in a 20-month period was analyzed with descriptive statistics, chi-square analysis, logistic regression, and power analysis. A modified risk score analysis was completed on all patients to assess comparability between the obstetrician and family physician patients. RESULTS: Risk score analysis of the two patient populations demonstrated no difference in high-risk patients (P = 0.102). Family physicians' patients had a lower incidence of Cesarean section, use of forceps, diagnosis of cephalopelvic disproportion, and low-birth-weight babies. They had a higher incidence of spontaneous vaginal delivery, vaginal birth after previous Cesarean section, and vacuum extraction use. The overall Cesarean section rate for family physicians was 15.4 percent, compared with 26.5 percent for obstetricians. CONCLUSIONS: These findings support the high-quality outcomes of perinatal care provided by family physicians. They also provide evidence for training and privileging family physicians to perform their own Cesarean sections.

Adolescent↗
PubMed1994

Incidence of neonatal sixth nerve palsy in relation to mode of delivery.

During a 10-year period on a level I neonatal service the total incidence (0.4%) and incidence by mode of delivery of neonatal lateral rectus paralysis occurring among 6886 term neonates was determined. The incidence of abducens nerve injury in this population increased progressively from 0% for deliveries by cesarean section to 0.1% for spontaneous vaginal delivery, to 2.4% for forceps delivery, and to 3.2% for vacuum extraction. This suggests that increased complexity of instrumentation during delivery is associated with an increased risk of sixth nerve palsy. A proposed mechanism for the injury to the sixth nerve is described.

Abducens Nerve Injury↗
PubMed2006

Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

OBJECTIVE: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. DESIGN: Longitudinal study. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: Women (4214) who returned postal questionnaires three months and six years after the index birth. METHODS: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. MAIN OUTCOME MEASURES: Urinary incontinence-persistent (at three months and six years after index birth) and long term (at six years after index birth). RESULTS: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by caesarean section was associated with both less persistent (OR=0.46, 95% CI 0.32-0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40-0.63). Caesarean section birth in addition to vaginal delivery, however, was not associated with significantly less persistent incontinence (OR 0.93, 95% CI 0.67-1.29). There were no significant associations between persistent or long term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. CONCLUSIONS: The risk of persistent and long term urinary incontinence is significantly lower following caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by caesarean section, the prevalence of persistent symptoms (14%) is still high.

Chronic Disease↗
PubMed1977

[Diabetes and pregnancy: treatment and results (author's transl)].

Pregnancy and delivery in 190 diabetic women are described. Obstetric, medical and neonatal guidelines for treatment are outlined and the following results are reported: 1. The delivery dates suggested by P. White were generally exceeded by 2 weeks. Group A was delivered at term, group B generally in the 38th week, group C between the 37th and 38th week and group D mostly in the 37th week of gestation. 2. Spontaneous delivery was achieved in 60% of the cases; Caesarean section was necessary in 33%, whilst the incidence of vacuum extraction was 5%. 3. The perinatal infant mortality rate in diabetic pregnancy decreased from 22.9% in 1970/71 to 2.7% in 1972/1976. 4. Perinatal mortality was related to the degree of severity of diabetes according to White's classification. 5. The percentage of PBSP cases was lowered from 32% to 24%. Perinatal mortality in the PBSP group decreased from 50% in 1970/71 to 19% in 1972/1976. 6. Hypoglycaemia occurred in 70% of 74 newborn infants submitted to intensive neonatal care. A true glucose value of less than 25 mg% was recorded in 30% of these cases. Hypocalcaemia was present in 16% cases, whilst 62% of the newborn infants suffered from respiratory distress syndrome. Cardiomegaly occurred in 28% of infants. 7. Development and prognosis are judged to be favourable in children of diabetic mothers.

Austria↗
PubMed1996

Operative vaginal delivery: a survey of fellows of ACOG.

OBJECTIVE: To document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency. METHODS: A survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by randomization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer ("recent," 31%), 11-20 years ("intermediate," 43%), and more than 20 years ("remote," 26%). RESULTS: The majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote; P < .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P = .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P = .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P < .001). CONCLUSIONS: The majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.

Data Collection↗
PubMed1992

[Risk of cerebral hemorrhage in premature and mature newborn infants].

We launched a prospective cranial ultrasound screening study at the Maternity Hospital of the University of Giessen to examine the incidence and severity of brain damage in newborns. More than 90% of all neonates born during 1984-86 were included in the study (n = 2781) and were screened for cerebral abnormalities on 5.9 +/- 3.3 (SD) day post partum. There were in 7.8% sonographic abnormalities, the most frequent being peri/intraventricular haemorrhages (5.2% PIVH of various degrees (grade I-III). Periventricular leucomalacia, porencephalia, subarachnoidal haemorrhages, and hydrocephali were rare (less than or equal to 0.2%). The incidence of PIVH increased progressively with decreasing gestational age, e.g. from 1.5% at 41 weeks up to 61% at 24-30 weeks of gestation. A large percentage of babies with cerebral haemorrhages were clinically normal. There was a close inverse relationship between the Apgar score at 1,5 and 10 min and both incidence and severity of PIVH. However, the relation between PIVH and both cardiotocography (matched-pairs analysis) and arterial cord blood-pH was poor. The incidence of PIVH was increased in growth retarded newborns (pH less than or equal to 7.29), preterm multiples and amnionitis, but not after preeclampsia and premature rupture of membranes. It is interesting to note that, in mature newborns (greater than or equal to 38 weeks), there was no difference in the incidence of PIVH between spontaneous deliveries, vacuum extractions, and Caesarean sections, and that there was no difference between vaginally delivered (1.5%) and sectioned breech presentations (3.5%) in this group. In preterms at 35-37 weeks with protracted labour and secondary Caesarean section, the incidence of PIVH was high (19%). We conclude, that neonatal cranial ultrasound screening is an important tool for risk assessment and quality control in obstetrics. It clearly improves both the quality of the advice given to the patients and the clinical management of high-risk pregnancies.

Acid-Base Equilibrium↗
PubMed1997

Red blood cell magnesium and hypoxic-ischaemic encephalopathy.

In developing countries, birth asphyxia is frequently associated with hypoxic ischaemic encephalopathy. This has been attributed to inadequate obstetric care but poor nutrition may also be important. This study determines the association between magnesium stores and hypoxic ischaemic encephalopathy. The level of red blood cell magnesium was measured on 572 women in labour and on selected offspring in a teaching hospital in South Africa. Fifty five of the 572 women delivered infants with hypoxic ischaemic encephalopathy and had significantly lower red blood cell magnesium levels (1.40 mmol/l) than controls. In the latter the levels varied somewhat with the mode of delivery, vertex births 1.76 mmol/l, Caesarean sections 1.67 mmol/l and vacuum extractions 1.61 mmol/l. Infants with hypoxic ischaemic encephalopathy had a significantly lower red blood cell magnesium level (1.39 mmol/l) than normal infants (1.61 mmol/l). Fifty four of 55 babies were black and from poor social circumstances and nutritional deficiency may be relevant. Maternal height, age and the duration of labour did not influence the chance of hypoxic ischaemic encephalopathy and affected infants were more likely than normal ones to be meconium stained (50%), to have a low Apgar score (58%) and to need endotracheal intubation at birth (54%). An intervention study in early pregnancy may determine magnesium's role in hypoxic ischaemic encephalopathy associated with asphyxia.

Apgar Score↗
PubMed1993

Pregnancy and delivery in women aged 35 years and over.

At the Medical Centre Department of Gynaecology and Obstetrics in Sibenik there were 26 116 deliveries over the 1970-1991 period, of which 1502 (5.75%) occurred in women aged 35 years and older. Among them 254 (0.97%) were primiparas, 1074 (4.11%) multiparas (two to four deliveries) and 174 (0.6%) grand multiparas (five deliveries and more). The control group consisted of 7920 primiparas, 7920 multiparas (two to four deliveries) and 80 grand multiparas (five deliveries and more) aged 20 to 34 years. There was no difference for occupation between the two groups (P > 0.05), whereas rural women (59.5%), unmarried women (4.2%), women with spontaneous (21.0%) or induced abortions (23.3%) were more common in the study group (P < 0.001). No antenatal visit received 5.9% and 1.8% (P < 0.001) in the study and control groups, respectively; the mean number of antenatal visits was 6.05 +/- 3.20 and 6.26 +/- 3.12, respectively (t = 2.41, P < 0.05). Threatened abortion (16.8%), EPH gestosis (9.5%), cervical cerclage (5.8%), weight gain above 14 kg (9.8%), preterm labour (8.4%), delivery at > or = 42 weeks (3.1%), premature rupture of the membranes (16.4%), meconium-stained amniotic fluid (14.4%), and up to 6-hour duration of labour (73.2%, elective caesarean section (6.8%), emergency caesarean section (5.7%), vacuum extraction (3.8%) and placental lysis or uterine exploration (3.8%) were more common in women > or = 35 years of age (P < 0.05). Higher rates for 7-to-12-hour duration of labour (33.6%) and episiotomy (64.2%) were found in the control group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Croatia↗
PubMed2005

Perinatal characteristics and obstetric complications as risk factors for asthma, allergy and eczema at the age of 6 years.

BACKGROUND: Considerable effort has been put into identifying early determinants for atopic disorders. Many studies have evaluated the role of fetal development and obstetric complications. However, the results are not unequivocal. STUDY OBJECTIVE: To assess the relationship between perinatal characteristics and obstetric complications, and the presence of reported current asthma, allergy and eczema at the age of 6 years in the framework of a previously conducted study. METHOD: Seven hundred families in the Netherlands with index children born in 1988-1990 were retrospectively selected. Data were extracted from the Municipal Health Service's records of health examinations of these children and their siblings. These examinations were carried out at the age of 6 years. The records contained data on reported atopic disorders and perinatal characteristics. RESULTS: Gestational age was inversely related to the risk of asthma (P for trend: 0.03). Children with low birth weight tended to have a lower risk of any allergy, albeit not significant (P=0.07). However, no link was found between neonatal head circumference and atopic disorders. The ratio of neonatal head circumference to birth weight was positively associated with the risk of atopic disorders, especially with the risk of asthma (odds ratio (OR)=1.87; 95% confidence interval (CI(95%))=[1.11, 3.15]). Vacuum extraction was a risk factor for allergy (OR=1.84, CI(95%)=[1.03, 3.28]), but not for asthma. Induced labour was positively associated with the risk of inhalant allergy (OR=2.22, CI(95%)=[1.09, 4.51]) and, to a lesser extent, asthma (OR=1.72, CI(95%)=[0.95, 3.10]). For caesarean section and forcipal extraction there were no such relationships. CONCLUSIONS: Prematurity is a risk factor for asthma reported at 6 years. A high ratio of head circumference to birth weight is a risk factor for any atopic disorder. Vacuum extraction was associated with a higher risk of allergy, and induced labour is a risk factor for inhalant allergy. All results should be viewed with the possibility of residual confounding.

Asthma↗
PubMed1969

Massive subaponeurotic haemorrhage in infants born by vacuum extraction.

Nine out of 232 infants on whom the vacuum extractor was employed developed subaponeurotic haemorrhage and two of these infants died. In a further 78 infants born by vacuum extraction, all of whom received intramuscular vitamin K(1), four sustained subaponeurotic haemorrhage and one died. This type of haemorrhage was not encountered in over 12,000 infants born by other methods. Its relationship to vacuum extraction was found to be significantly more frequent when the thrombotest level was 10% or below of normal adult activity. It is suggested that infants born by vacuum extraction and with a thrombotest level of 10% or below might be protected from subaponeurotic haemorrhage by the transfusion of fresh frozen plasma.

Blood Coagulation Tests↗