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PubMed1989

[Eye diseases and control of labor. Studies of changes in the eye in labor exemplified by subconjunctival hemorrhage (hyposphagmas)].

The possible significance of subconjunctival bleedings (hyposphagmas) as a symptom for other pathological changes of the eye was studied in a group of 354 postpartum patients. They were found in 10.5% of the cases. A relatively higher frequency occurred in primiparas. No other maternal factors than parity were detected as of statistically significant influence. A slightly higher percentage in mothers with large newborn (above average cranial circumference) indicates a relationship to the necessary bearing-down effort. In a second study, 49 postpartum women with subconjunctival bleeding were examined by an ophthalmologist. Neither any intraocular or retrobulbar bleeding nor any other grievous damage to the eye were found. In accordance with the literature we recommend, that highly myopic pregnant women (even with a previous history of retinal detachment, but ophthalmologically sufficiently treated) should undergo induced delivery. However, the approach to pregnant women with retinal detachment occurring and treated during pregnancy, or to glaucoma-patients with risk to a small remaining visual field, should be more careful. In those cases, a vaginal operative delivery procedure (forceps, vacuum-extraction) is recommended. Nevertheless, one should consider individual wishes of the mother, when striving to diminish the risk to the foetus. The same applies to irrational fears related to previously damaged (and possibly only functional) eye.

Adult↗
PubMed2002

Risk factors for arrest of descent during the second stage of labor.

OBJECTIVE: To define obstetrical risk factors for arrest of descent during the second stage of labor and to determine perinatal outcome. STUDY DESIGN: All singleton, vertex, term deliveries with an unscarred uterus, between the years 1988 and 1999 were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor and the perinatal outcome. RESULTS: The study included 93266 deliveries, of these 1545 (1.7%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: nulliparity (OR=7.8, 95% CI=6.9-8.7; P<0.001), birth weight >4 kg (OR=2.3, 95% CI=1.9-2.8; P<0.001), epidural analgesia (OR=1.8, 95% CI=1.6-2.0; P<0.001), hydramnios (OR=1.6, 95% CI=1.3-2.0; P<0.001), hypertensive disorders (OR=1.5, 95% CI=1.3-1.8; P<0.001), gestational diabetes A1 and A2 (OR=1.5, 95% CI=1.2-1.8; P<0.001), male gender (OR=1.4, 95% CI=1.2-1.5; P<0.001), premature rupture of membranes (PROM, OR=1.3, 95% CI=1.04-1.6; P=0.021), and induction of labor (OR=1.2, 95% CI=1.02-1.4; P=0.030). Deliveries complicated by arrest of descent resulted in cesarean section in 20.6%, vacuum extraction in 74.0%, and forceps delivery in 5.4%. Newborns delivered after arrest of descent during the second stage of labor had significantly higher rates of low Apgar scores (<7) at 1 and 5 min, as compared to the controls (12.7 vs. 2.1%, P<0.001; and 0.9 vs. 0.2%, P<0.001, respectively). Nevertheless, no significant differences were noted between the groups regarding perinatal mortality (0.38 vs. 0.44%; P=0.759). CONCLUSIONS: Major risk factors for arrest of descent during the second stage of labor were nulliparity, fetal macrosomia, epidural analgesia, hydramnios, hypertensive disorders and gestational diabetes mellitus. These risk factors should be carefully evaluated during pregnancy in order to actively manage high-risk pregnancies.

Analgesia, Epidural↗
PubMed1986

Extradural analgesia and retinal haemorrhage in the newborn.

The incidence and severity of retinal haemorrhage were examined in 976 babies born by vaginal delivery. The influence of the method of analgesia, instrumental delivery and parity was studied. The mothers of 638 infants received extradural analgesia, while the other 338 received either narcotics or no analgesia. Extradural analgesia did not lead to a higher incidence of retinal haemorrhage, even though the number of vacuum extractions was doubled. With increasing parity, the total frequency and the frequency of severe retinal haemorrhage decreased (P less than 0.001). Severe retinal haemorrhage was not seen in any baby of whom the mother was para 4 or more.

Anesthesia, Epidural↗
PubMed2002

[Anesthesia and analgesia in obstetrics].

Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving anesthesia for cesarean sections in the operating room. Over the last years the treatment of labor pain with epidural anesthesia has been modified. Whereas a couple of years ago local anesthetics were used almost exclusively, the recent trend goes toward a combination of local anesthetics with opioids. Using this combination the total amount of local anesthetic can be greatly reduced, whilst maintaining most of the motor function during labor. There is evidence the combination of local anesthetics with opioids can reduce the number of operative vaginal deliveries such as vacuum extraction or forceps. The systemic application of opioids remains unaffected by the local application and its significance is unaltered, even though the effectiveness compared to epidural application in managing labor pain is far inferior. Opioids applied systemically often have an unwanted sedative effect in the mother and have the potential for respiratory depression in the newborn. The question, whether epidural anesthesia increases the frequency of cesarean sections remains to be answered. Studies so far present discrepant results and do not show a causal relationship between the use of epidural anesthesia and increase in cesarean section rate. Regarding cesarean sections, there has been a trend in the operative field over the last years towards the use of regional anesthesia. This is the consequence of the fact that anesthesia related mortality during cesarean sections is still mainly due to hypoxia and aspiration during induction of anesthesia. The advantage of spinal anesthesia over epidural anesthesia is faster onset, more reliable sensitive block and a lower failure rate. Downside of the use of spinal anesthesia is a higher incidence of hypotension in the mother, which, however, is not a serious complication if treated adequately. Regarding the continuous application of local anesthetics via a spinal catheter, no definite statements towards benefits compared to other regional techniques can be made due to the lack of adequate amount of patient studies. Theoretically this method seems advantageous as it allows to adjust the administration of local anesthetics and opioids to the individual needs in a very refined way. Emergency situations, such as emergency cesarean sections, life threatening hemorrhage, eclampsia, and HELLP syndrome, are the main risks of the anesthetic practice in obstetrics. Their beneficial outcome is highly dependent on the coordination of logistic problems, good communication and coordination within an interdisciplinary team of obstetricians and anesthesiologists.

Analgesia, Obstetrical↗
PubMed1999

[Intracranial arteriovenous malformations in pregnant women].

Three women, aged 27, 32 and 30 years, respectively, suffered from headache, nausea and neurological abnormalities and were found to have an intracranial arteriovenous malformation (AVM). One of them after diagnosis had two pregnancies, both ended by caesarean section with good results. Another woman was 32 weeks pregnant when the AVM manifested itself with a haemorrhage; she recovered well and was delivered by caesarean section. After the AVM proved radiologically to have been obliterated, she delivered after her subsequent pregnancy by the vaginal route with vacuum extraction. The third woman was 15 weeks pregnant when major abnormalities developed. There was a large intracerebral haematoma with break-through to the ventricular system; this patient died. Intracranial haemorrhage during pregnancy is rate. It can result in maternal and foetal morbidity and mortality. It appears that pregnancy does not increase the rate of first cerebral haemorrhage from an AVM. The management of AVM rupture during pregnancy should be based primarily on neurosurgical rather than on obstetric considerations. Close collaboration with a team of neurologists, neurosurgeons, obstetricians and anaesthesiologists is mandatory.

Adult↗
PubMed1990

Pregnancy after laser therapy for the treatment of uterine cervical neoplasia.

Three hundred and twenty-four patients with cervical intraepithelial neoplasia (33 mild dysplasia, 109 moderate dysplasia, 118 severe dysplasia, 64 carcinoma in situ) underwent laser vaporization with the CO 2 laser. Eighty-two patients with CIN (mild dysplasia 7, moderate dysplasia 10, severe dysplasia 16, carcinoma in situ 46) and microinvasive cancer (3) underwent laser excisional conization with the YAG laser. Their first cure rates showed 93.5% and 98.8%, respectively, for the follow-up period 6 months to 7 years. During the same period, 36 pregnancies in 34 patients occurred. Of these patients, 14 underwent dilatation and curettage, 6 terminated by spontaneous abortion in the first trimester and 1 in the second trimester (previous MacDonald's suture), and 1 had fetal death at 13 weeks of gestational age. There were 13 deliveries, 2 by cesarean section (either postenucleation of uterine myoma or premature rupture of the membranes and fetal distress), 3 by vacuum extraction, 1 by breech delivery, and 7 by normal vaginal delivery. One patient is currently in her 22nd week of pregnancy. Our laser therapies are good conservative methods for the treatment of CIN because of favorable cure rates and no effect on succeeding pregnancy and delivery.

Adult↗
PubMed1987

Cephalhaematoma: a 10-year review.

The incidence of cephalhaematoma at the Mercy Maternity Hospital over a 10-year period was 2.5%; of the 1,030 infants 68.4% were born to primiparas, 65.6% were males, the majority (91.1%) were between 37 and 42 weeks' gestation and 3,000 and 4,000 g birth-weight (71.6%). Forceps delivery and vacuum extraction were associated with increased incidences of cephalhaematoma (5.1% and 22.9% respectively), and the incidence was slightly increased (3.8%) when a scalp electrode had been applied. Hyperbilirubinaemia was more prevalent (12.9%) in infants with a cephalhaematoma as was exchange transfusion (0.8%) and the need for phototherapy (4.9%).

Birth Injuries↗
PubMed1998

Pregnancy outcome in aboriginal women with NIDDM in the Sioux Lookout Zone.

PURPOSE: To review the pregnancy outcomes of Aboriginal women with non-insulin-dependent diabetes mellitus (NIDDM) in the Sioux Lookout Zone of Northwestern Ontario, Canada. METHOD: Retrospective chart review of deliveries of all women with a confirmed diagnosis of NIDDM was carried out between 1989 and 1992. RESULTS: During this period, 26 infants were born to 19 women with the diagnosis of NIDDM. Mean birth weight was 4,075 grams, with an average gestational age at delivery of 38 weeks. Three newborns required cesarean delivery, one required forceps, and one a vacuum extraction. There were four cases of shoulder dystocia. There were one stillbirth, one maternal death, and two cases of congenital heart disease. Ten newborns had neonatal jaundice and only two had neonatal hypoglycemia. These results suggest there is significant risk associated with NIDDM in pregnancy.

Adolescent↗
PubMed1991

The patient observer: does the hands-and-knees posture during labor help to rotate the occiput posterior fetus?

Retrospective chart review was conducted for four low-risk women with full-term, healthy fetuses in the occiput posterior position. The first woman pushed for over two hours and delivered a 6 lb, 8 3/4 oz baby by cesarean section. The second woman delivered a 5 lb, 2 3/4 oz baby posteriorly by vacuum extraction and had a third-degree laceration. The third and fourth women both assumed the hands-and-knees posture during labor; their infants weighted 7 lb, 7 3/4 oz and 7 lb, 11 3/4 oz, respectively. Both of these fetuses rotated to the anterior position and were born spontaneously without complications.

Adult↗
PubMed1981

[Pressures on the human fetus during labor - intrauterine and on the fetal head (author's transl)].

During labor, the body surface of the fetus is subjected to strong pressure exerted by uterine contractions. In 40 cases, intrauterine pressure (IUP) which acts on the fetal body in the uterine cavity and pressure between the presenting part of the fetus and birth canal (PFB) which acts on the part of the fetus engaged in the birth canal were measured to determine the difference in pressure depending on the parts of the fetal body and their changes during the progress of labor. 1) Both peak IUP and PFB values increased gradually in the first stage of labor, and they became double in the period of labor with bearing-down efforts. 2) Since the peak value of PFB was 2.2 to 3.5 times higher than that of IUP, the part of the fetus engaged in the birth canal should always be subjected to 2.2 to 3.5 times more pressure than the intrauterine part of the fetal body. 3) Manual procedures such a vacuum extraction and Krysteller's compression on the uterine fundus increased the peak value of PFB markedly. The objective measurement of the pressure which acts on the fetal head during labor can be considered to contribute to the prevention of cerebral damage and fetal hypoxia.

Female↗
PubMed1992

The grand multipara--an obstetric problem?

At the Medical Central Department of Obstetrics and Gynecology in Sibenik over 1970-1991 period there were 26,116 deliveries (multiple births excluded), of which 254 (0.97%) occurred in grand multiparas (five and more deliveries). The authors have found that the number of grand multiparas decreased by 38.3% (P < 0.001) over the past eleven years. Control subjects were 7920 multiparas (two to four deliveries, 20-34 years of age, from the same period). In 84.3% of the cases grand multiparas were delivered of their fifth or sixth infant, and 68.5% were > or = 35 years of age. Spontaneous abortion occurred in 16.9%, and 14.2% had no antenatal visit. EPH gestosis (8.3%), glucose intolerance (9.9%), preterm delivery (8.3%) and meconium-stained amniotic fluid (15.0%) were more common in the grand multiparas, whereas cervical cerclage (5.4%) and 7-to-12-hour duration of labour (12.8%) were more common in the control group. No significant differences were found in weight gain, prolonged pregnancy, caesarean delivery, assisted breech and vacuum extraction between two groups. There was also no difference in the incidence of neonatal morbidity and congenital abnormalities between the grand multiparas and controls. Late fetal and early neonatal deaths in the grand multiparous and control group occurred in 1.18% and 1.57, respectively, resulting in a 2.75% overall perinatal death rate for both groups (P > 0.05). No case of maternal death or uterine rupture occurred in either group. The authors conclude that pregnancy and delivery in grand multiparas are at higher risk due to poorer antenatal care and advancing maternal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

[Instrumental and manual maneuvers during delivery].

Delivery through the maternal genital tract can be assisted or performed using specific instruments. In France, these techniques are used in 15% of deliveries. The three instruments used are the forceps, the vacuum extractor and the spatula. Manual manoeuvres are essentially used in breech presentation. These are mainly partial and total breech extractions with their many variations. The version consisting of external manoeuvering precedes delivery. In cephalic presentations, the only possible manual manoeuvre is manual rotation of the foetal head.

Extraction, Obstetrical↗
PubMed1991

Safe epidural anesthesia performed during labor by an obstetrician.

One thousand seven hundred eighty-seven epidural anesthesias during labor were performed by obstetricians well trained in the technique by the anesthesiology department. The course of labor was accelerated compared to control group. Vacuum extraction rate was 11.9%. Fetal outcome was favorable. Incidence of major complications was 0.16%. We conclude that in countries where an anesthetist is not routinely available at delivery wards, a safe and efficient epidural anaesthesia could be performed by an obstetrician well trained in administration of epidural anesthesia.

Anesthesia, Epidural↗
PubMed2001

Trends in the use of episiotomy in the United States: 1980-1998.

BACKGROUND: Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy. METHODS: Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short-stay non-Federal hospitals. RESULTS: From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self-pay category. The incidence of first- and second-degree lacerations to the perineum increased for women without episiotomies, but the more severe third- and fourth-degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps-assisted deliveries or vacuum extractions. CONCLUSIONS: Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.

Adult↗
PubMed1993

Risk factors for neonatal hyperbilirubinemia.

The purpose of this Historical Prospective Study was to analyze factors associated with neonatal hyperbilirubinemia. Data were collected from summary labour records and individual patients' records at Ramathibodi Hospital between January 1, 1988 and December 31, 1988. Of the 7,644 livebirths, neonatal hyperbilirubinemia (> or = 15 mg/100 ml) occurred in 638 cases. There was a statistically significant positive relationship between hyperbilirubinemia and vacuum extraction (RR 2.7), preterm delivery (relative risk, RR 2.1), low birthweight (RR 2.0), antepartum complication (RR 1.7), intrapartum complications (RR 1.5), forceps delivery (RR 1.4), and oxytocin infusion (RR 1.3). No significant relationship emerged between hyperbilirubinemia and fetal sex, cesarean section, breech delivery and the 5 min Apgar score. From 1984 to 1988 there was a pronounced increase in the incidence of neonatal hyperbilirubinemia in Ramathibodi Hospital. This increase was consistent with the increase in use of oxytocin infusion which reflects changes in obstetric practice. Provision of information, education and communication about this adverse effect to obstetricians and auditing their use are suggested solutions.

Female↗
PubMed2004

Third degree perineal tears in a university medical center where midline episiotomies are not performed.

OBJECTIVE: Midline episiotomy is a known major risk factor for severe perineal lacerations. The study was aimed to define obstetric risk factors for third-degree perineal tears in a university medical center where midline episiotomies are not performed. STUDY DESIGN: A comparison between vaginal deliveries complicated with third-degree perineal tears and deliveries without third-degree perineal tears was performed. Deliveries occurred between the years 1988-1999 in a tertiary medical center. Multiple gestations, preterm deliveries (<37 weeks' gestation), cesarean deliveries and cases of shoulder dystocia were excluded from the analysis. A multiple logistic regression model was constructed in order to find independent risk factors for third-degree perineal tears. Odds ratios (OR) and their 95% confidence interval (CI) were calculated from the regression coefficient. RESULTS: During the study period, 79 (0.1%) consecutive cases of third degree perineal tears were identified. Significant risk factors from the univariate analysis were fetal macrosomia (OR 2.7, 95% CI 1.2-5.5), nulliparity (OR 2.9, 95% CI 1.8-4.6), labor induction (OR 1.9, 95% CI 1.0-3.5), failure of labor to progress during the second stage (OR 10.8, 95% CI 5.4-21.1), non-reassuring fetal heart rate patterns (OR 11.7, 95% CI 6.1-21.5), mediolateral episiotomy (OR 2.8, 95% CI 1.8-4.5), vacuum extraction (OR 10.6, 95% CI 6.1-18.3), and forceps delivery (OR 29.2, 95% CI 7.3-97.2). However, using a multivariable analysis, only fetal macrosomia (OR 2.5, 95% CI 1.2-4.9), vacuum extraction (OR 8.2, 95% CI 4.7-14.5), and forceps delivery (OR 26.7, 95% CI 8.0-88.5) remained as independent risk factors. The combined risk for instrumental deliveries of macrosomic newborns was 8.6 (95% CI 1.2-62.5; p=0.010). CONCLUSIONS: After adjustment for possible confounding variables, mediolateral episiotomy per se was not an independent risk factor for third-degree perineal tears. Instrumental vaginal deliveries of macrosomic fetuses should be avoided whenever possible to decrease the occurrence of third-degree perineal tears.

Adult↗
PubMed1990

Painless labour at Ramathibodi Hospital.

Epidural anesthesia for labour is good for relieving labour pain. There were 43 per cent spontaneous deliveries, 33.6 per cent forceps extractions, 13.1 per cent vacuum extractions and 10.3 per cent cesarean sections. Total amount of anesthetic solution varied between 16 to 29 ml and anesthetic levels were T10, T9 and T8. The majority of the infants had apgar score 9 or 10 in the first minute of life. There were minor complications such as backache, urinary retention and hypotension which were treatable without permanent sequalae.

Anesthesia, Epidural↗