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PubMedDate not supplied

[Disorders of bladder emptying after labor. Study of 511 puerperal patients regarding the incidence and risk of residual urine post partum].

In a Study of 500 unselected women in childbed interested the incidence and risk factors of residual urine over 50 ml (RH), sonographically proven in the first days after birth. The incidence after vaginal birth was 17% and after C-section 13%, 7% and 1% suffered from a urinary tract infection respectively. The RH-phenomenon lasted approximately 3 days. Significant risk factors have been: vaginal-operative deliveries (forceps, Vacuum-Extraction) protracted deliveries (over 12 hours) protracted expulsion period (over 1 hour) longer expulsive periods (over 15 minutes) newborn head-circumference over 36 cm I-Parae with episiotomy -PDA had only an additive effect. The shown quantitative aspects make it easier to evaluate the risk and the exact sonographic search for residual urine in the days pp.

Adult↗
PubMed1971

Results in 1,000 cases of therapeutic abortion managed by vacuum aspiration.

A prospective study of 1,000 cases of termination of pregnancy by vacuum aspiration is presented and the safety of the method emphasized. By setting up special clinics and an additional weekly operating session, the maximum delay from a request to appointment is 5 days, and, if operation is advised, from appointment to operation a further 7 days.

Abortion, Legal↗
PubMed1985

X-ray pelvimetry and trial of labor after previous cesarean section. A prospective study.

The benefits of X-ray pelvimetry and electronic monitoring of fetal heart rate and intra-uterine pressure were studied prospectively in order to predict the likelihood of a successful vaginal birth after previous cesarean section (CS). In 1982, a total of 369 parturients (7% of all deliveries) who had previously undergone CS were studied. Trial of labor (TL) was allowed in 160 cases (43.4%) and planned repeat CS was performed in 209 patients (56.6%). Patients in the TL group were compared with a matched control group. One hundred and fifty patients (94%) in the TL group gave birth by the vaginal route. There were no differences in the duration of the first and second stage of labor, duration of ruptured membranes (ROM), maternal blood loss or the incidence of CS and vacuum extraction between the TL group and the control group. Rates of low Apgar score (less than 7) at 1 and 5 min were the same in both groups. Intensive fetal monitoring during the course of labor, together with X-ray pelvimetry in selected cases, markedly reduced the incidence of acute repeat CS with no change in the overall rate of successful vaginal delivery compared with our previous results.

Cesarean Section↗
PubMed1987

Fear of failure: a place for the trial of instrumental delivery.

The safety of performing potentially difficult midcavity forceps or vacuum extractions, as trials of instrumental delivery was assessed retrospectively. Successful vaginal delivery was achieved in 61% of 122 patients with delay in the second stage who had a trial of instrumental delivery performed in an operating theatre with full preparations to proceed to caesarean section. The outcome was compared with that in 42 patients who were delivered for the same indication, by primary caesarean section, without prior instrumentation. Transient fetal trauma occurred only in the trials of instrumental delivery, and there was no significant difference in immediate neonatal or maternal morbidity. In another group of 61 patients instrumental delivery was attempted without full preparations for possible caesarean section and when unexpected difficulty arose, the forceps or vacuum extractor were abandoned in favour of caesarean section. Within this group of unexpected failures of instrumentation there were significantly more babies with low Apgar scores, delayed onset of respirations or needing intubation. A carefully conducted trial of instrumental delivery is an acceptable alternative to caesarean section for delay in the second stage due to a potentially difficult midcavity arrest.

Adult↗
PubMed2002

Prevalence and persistence of health problems after childbirth: associations with parity and method of birth.

BACKGROUND: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies examining their duration have been published. The aim of this study was to describe changes in the prevalence of maternal health problems in the 6 months after birth and their association with parity and method of birth. METHODS: A population-based, cohort study was conducted in the Australian Capital Territory (ACT), Australia. The study population, comprising women who gave birth to a live baby from March to October 1997, completed 4 questionnaires on the fourth postpartum day, and at 8, 16, and 24 weeks postpartum. Outcome measures were self-reported health problems during each of the three 8-week postpartum periods up to 24 weeks. RESULTS: A total of 1295 women participated, and 1193 (92) completed the study. Health problems showing resolution between 8 and 24 weeks postpartum were exhaustion/extreme tiredness (60-49), backache (53-45), bowel problems (37-17), lack of sleep/baby crying (30-15), hemorrhoids (30-13), perineal pain (22-4), excessive/prolonged bleeding (20-2), urinary incontinence (19-11), mastitis (15-3), and other urinary problems (5-3). No significant changes occurred in the prevalence of frequent headaches or migraines, sexual problems, or depression over the 6 months. Adjusting for method of birth, primiparas were more likely than multiparas to report perineal pain and sexual problems. Compared with unassisted vaginal births, women who had cesarean sections reported more exhaustion, lack of sleep, and bowel problems; reported less perineal pain and urinary incontinence in the first 8 weeks; and were more likely to be readmitted to hospital within 8 weeks of the birth. Women with forceps or vacuum extraction reported more perineal pain and sexual problems than those with unassisted vaginal births after adjusting for parity, perineal trauma, and length of labor. CONCLUSIONS: Health problems commonly occurred after childbirth with some resolution over the 6 months postpartum. Some important differences in prevalence of health problems were evident when parity and method of birth were considered.

Adolescent↗
PubMed1999

Congenital muscular torticollis and sternomastoid tumor: results of nonoperative treatment.

BACKGROUND: Congenital muscular torticollis (CMT) and sternocleidomastoid tumor of infancy remains to be one of the mysteries of pediatric surgery. Its cause is still debated and its management is controversial. METHODS: Fifty-seven infants and children treated consecutively for sternomastoid tumors and CMT over a 5-year period (1992 to 1997) at the Pediatric Surgery Clinic of Social Security Council Ankara Children's Hospital are reviewed. The obstetric history was recorded in 48 patients. A lump in the neck, head tilt, plagiocephaly, and facial asymmetry were reasons for refferal correlating with the age of admission. Under 18 months of age passive and active stretching exercises (PSE and ASE) were initiated in all of the cases. RESULTS: In 28 children under the age of 3 months the outcome was excellent with none needing surgery. Successively 25% of the 3- to 6-month-old infants, 70% of the 6- to 18-month-old children, and 100% of all the older children required surgery. Spontaneous normal vaginal delivery was recorded in 23 of 48 (48%) cases, whereas vaginal vacuum extraction in four cases, vaginal forceps in six, vaginal as breech in two, and caesarean section in 11 was noted. CONCLUSIONS: It was concluded that PSE and ASE are highly effective for the treatment of congenital muscular torticollis. The success rate of conservative treatment is primarily dependent on the patients' age at the initiation of exercises. The hypothesis of injury through the birth canal and intrauterine malposition are valid only in 12 (25%) and 13 (27%) of cases, respectively. Therefore, it is difficult to attribute as an etiologic factor.

Age Factors↗
PubMed1986

Annuality of birth, delivery types and sex ratio in Tehran, Iran.

616,638 births during 1967-1983 from a maternity hospital in Tehran (Iran) have been considered for the present study. The mean rate of normal delivery was 92.59%, that of Caesarean was 3.09%, that of wantose was 1.52% and finally that of forceps was 1.31%. Caesarean and wantose (vacuum extractor) delivery types showed an increasing trend, whereas the normal and forceps delivery types showed a decreased trend during the period under study. The secondary sex ratio was the highest in 1977 and the lowest in 1983 with a mean of 105.18. The twinning rate showed a decreasing trend during the above period.

Birth Rate↗
PubMed1983

The effect of parturition on umbilical blood plasma levels of norepinephrine.

The norepinephrine concentration in 77 umbilical, arterial, and venous plasma samples, and in 31 simultaneous maternal plasma samples, was measured. The mean (+/- SEM) of 8.7 +/- 1.9 ng/ml in the umbilical artery was higher (P less than .001) than that of 3.6 +/- 0.9 ng/ml in the umbilical vein. In paired fetal-maternal venous samples the norepinephrine concentration of 3.8 +/- 1.7 ng/ml in the fetus was higher (P less than .05) than that of 0.3 +/- 0.1 ng/ml in the mother. Among the different types of vaginal deliveries the umbilical arterial norepinephrine concentrations were: 5.8 +/- 2.1 ng/ml in uncomplicated vaginal deliveries; 16.4 +/- 2.1 ng/ml in breech deliveries (P less than .05 as compared with uncomplicated vaginal deliveries); 8.8 +/- 2.5 ng/ml in vacuum extraction deliveries; and 0.8 +/- 0.3 ng/ml and 11.3 +/- 7.7 ng/ml in twin A and twin B deliveries, respectively. All these values were higher (P less than .001) than those after elective cesarean section, except that for twin A, which was lower (P less than .01) than that for twin B, indicating that labor and vaginal delivery induced activation of the fetal sympathoadrenal system.

Adult↗
PubMedDate not supplied

Continuous female companionship during childbirth: a crucial resource in times of stress or calm.

Continuous support by a lay woman during labor and delivery facilitates birth, enhances the mother's memory of the experience, strengthens mother-infant bonding, increases breastfeeding success, and significantly reduces many forms of medical intervention, including cesarean delivery and the use of analgesia, anesthesia, vacuum extraction, and forceps. The contribution of doula care has become increasingly available in industrial countries and is beginning to be adopted in hospitals in underdeveloped countries. Research continues to demonstrate the far-reaching value of supportive companionship as a corollary to professional health care during birth. Mothers who are at risk because of medical or social factors and those delivering in situations of stress, including disasters, can benefit greatly from labor support.

Attitude to Health↗
PubMedDate not supplied

Intracranial and extracranial hemorrhages in newborns with hemophilia: a review of the literature.

PURPOSE: Intracranial hemorrhage (ICH) and extracranial hemorrhage (ECH) in newborns with hemophilia were reviewed with respect to incidence, anatomic location, clinical presentation, and relationship to the mode of delivery and type of hemophilia. MATERIALS AND METHODS: A MEDLINE search from 1964 to 1996 of all reports of neonatal hemophilia and head bleeds in children from birth to 1 month old was performed. ICH was defined as any bleed occurring within the cranial cavity, and ECH was defined as hemorrhage occurring outside of the cranial cavity, including subgaleal and cephalhematoma. The mode of delivery, type and severity of hemophilia, and clinical presentation were also noted. RESULTS: One hundred two newborns with hemophilia and cranial bleeds were described in 33 publications. The cumulative incidence of ICH and ECH was 3.58% in 5 studies that reported the total newborn population or that examined birth records. The type of hemophilia was reported for 40 of 102 newborns and was hemophilia A in 87%. The mode of delivery was recorded in 46% (47 of 102) of the patients. Of these, 13% had cesarean delivery, and 87% were delivered vaginally (40% had spontaneous vaginal delivery, and 47% had vaginal delivery with vacuum extraction or forceps). There were 109 episodes of ICH and ECH (65% were ICH, 35% were ECH, and 5.8% were a combination of both). Common clinical features of ICH and ECH included anemia, hypotension, shock, and lethargy. However, only patients with ICH were reported to have neurologic deficits (15%) and late neurologic sequelae (38%). CONCLUSION: In neonates with hemophilia and cranial bleeds, ICH occurs more often and is often associated with late neurologic deficits.

Cerebral Hemorrhage↗
PubMed1974

Survey of neonatal jaundice in Port Moresby.

Neonatal jaundice is a common problem in Port Moresby. A survey was carried out on 50 consecutive jaundiced neonates in an attempt to delineate the causes of severe neonatal jaundice (bilirubin 15 mg. % or more). ABO blood group incompatibility, G-6-P-D deficiency and infection accounted for 62% of cases while no cause could be found in 38% of cases. Low birth weight, multiple births, male sex, asphyxia, delivery occuring outside the hospital, and vacuum extraction were associated more commonly with jaundiced neonates than with the controls. There was a statistically significant association between the use of promethazine in the mother during and after labour and jaundice in the newborn. The association between the use of sulphonamides in the mother after delivery and neonatal jaundice was suggestive but not statistically significant.

ABO Blood-Group System↗
PubMed2006

Neonatal subgaleal hematoma: presentation and outcome--radiological findings and factors associated with mortality.

To describe the presentation and outcome of infants who develop subgaleal hematoma (SGH), we compared perinatal factors, clinical and head imaging findings, and outcome in a cohort (N = 34) of all infants admitted to Saint Louis Children's Hospital neonatal intensive care unit with SGH from January 1991 to June 2003. All except three of the infants admitted with SGH had instrumental deliveries (31 of 34; 91.2%): 21 vacuum, eight vacuum followed by forceps, two forceps). There was also a high frequency of occurrence of associated intracranial hemorrhage (17 of 34; 50%: subarachnoid hemorrhage, n = 4; intraventricular hemorrhage, n = 4; intraparenchymal hemorrhage, n = 4; subdural hemorrhage, n = 11), and skull fracture (six of 34; 19.4%; three of six [50%] of them depressed fractures). There was mortality associated with SGH (four of 34, 11.8%); those who died had significant volume loss with anemia, coagulopathy, and shock requiring large volumes of blood and blood products transfusions. The presence of ICH did not correlate with the severity of SGH or mortality, but the severity of SGH correlates with mortality. Minor neurological abnormalities were noted in only four infants at discharge. In conclusion, SGH is an uncommon type of birth trauma, and is associated with delivery or attempted delivery by instrumentation (vacuum and/or forceps). Severe hypovolemia and coagulopathy, but not intracranial hemorrhage, were the most commonly associated clinical problems with mortality. ICH does not correlate with severity of SGH. A brain computed tomography or magnetic resonance imaging should be considered in evaluating a clinically symptomatic SGH. There is associated mortality in severe cases but short-term outcome in survivors is good.

Birth Injuries↗
PubMed1997

Fetal macrosomia and management of delivery.

During the period 1988-1966, 737 pregnancies, in which the infant birth weight was > or = 4000 grams were studied. During the same period there were 11,631 newborns, and 6.3% of them were infants with a birth weight > or = 4000 grams. Normal vaginal delivery occurred in 583 cases (79.1%), vacuum extraction in 24 cases (3.3%) and caesarean section in 130 cases (17.6%). Regarding the caesarean section, 38 (29.2%) of them were elective and 92 (70.8%) were done in different periods of the labour. In these macrosomic babies perinatal death never occurred, but different pathological neonatal outcomes were observed and the majority of these were clavicle abruptions (39 cases: 5.3%). Maternal morbidity observed in the 607 (82.4%) cases with vaginal delivery is characterized by: 60 cases (9.8%) of vaginal and perineal tears, 4 cases (0.6%) of cervical tears, and 2 cases (0.3%) of pubic symphysis traumatic diastasis. Shoulder dystocia is the most likely outcome in fetal macrosomic delivery; for this reason we considered the diagnostic and therapeutic management of this obstetrical complication. Because the normal outcome of neonatal births actually encourages the preference for normal vaginal delivery, we concluded that mothers with macrosomic fetuses can safely be managed expectantly unless there is a high maternal and fetal risk.

Adolescent↗
PubMed1999

The influence of prepregnancy body mass index on labor complications.

BACKGROUND: To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS: From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS: High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS: Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

Body Mass Index↗
PubMed1992

Intervention during labor: risk factors associated with complete tear of the anal sphincter.

Among 41,200 consecutive deliveries there were 152 cases of complete tear of the anal sphincter (complete tear). In a case-control design, the association between interventions during labor (forceps, vacuum extraction, use of oxytocin and prostaglandins and mediolateral episiotomy) and complete tear, were evaluated by confounder control using multiple logistic regression analysis. Controls chosen were the patients delivering just before and after the index patient with complete tear. Use of Kielland forceps, mediolateral episiotomy, shoulder dystocia and nulliparity were significantly associated with complete tear. Maternal age, presentation in labor, duration of second stage of labor and the indication for instrumental deliveries and episiotomy had no significant association with complete tear.

Adult↗
PubMed1993

Vaginal delivery from the persistent occiput posterior position. Influence on maternal and neonatal morbidity.

We performed a retrospective study of 564 vaginal occiput posterior (OP) deliveries to investigate the influence of this position on maternal and fetal morbidity. The cases were compared to 1,068 controls matched for race, parity and delivery method. The OP group had a higher incidence of severe perineal laceration and episiotomy than the occiput anterior (OA) group. Within the OP group, operative delivery was associated with a higher incidence of severe perineal laceration, vaginal laceration and episiotomy than was spontaneous delivery. Similarly, the OP group delivered by forceps had a higher incidence of severe perineal lacerations, vaginal lacerations and episiotomy than those delivered by vacuum extraction. Mediolateral episiotomy was associated with a lower incidence of severe perineal lacerations than median episiotomy during delivery from the OP position. The infants delivered from the OP position had a higher incidence of Erb's and facial nerve palsy than did those delivered from the OA position. All these injuries occurred following forceps delivery. Vaginal delivery from the persistent OP position is associated with increased maternal morbidity, and operative vaginal delivery from this position is associated with increased neonatal morbidity.

Delivery, Obstetric↗
PubMed2001

Features of shoulder dystocia in a busy obstetric unit.

OBJECTIVE: To assess the incidence and complications of shoulder dystocia and whether those complications could be avoided. STUDY DESIGN: Retrospective analysis of shoulder dystocia between 1996 and 1999 to determine whether macrosomia, diabetes, height of head at full dilatation, length of second stage or instrumental delivery could predict shoulder dystocia. Fetal asphyxia, brachial plexus injury, maneuvers used to free the shoulders and experience of the attendant were also assessed. RESULTS: There were 56 cases of shoulder dystocia in 24,000 births, 59% after spontaneous delivery. McRoberts maneuver was used in 48 deliveries but sufficed as a solitary procedure in nine cases. The addition of suprapubic pressure was sufficient for 25 patients and 27 when bilateral episiotomy was also used. Corkscrew procedures were required in 12 patients. Midwives were involved in 35 cases and required assistance in 27. Macrosomia > 4,000 g was a feature in 20 infants and diabetes in 6. Neither the height of the head nor the length of the second stage was helpful. There were 13 cases of Erb's palsy, seven after vacuum delivery and six after spontaneous delivery. Eight of these cases were associated with McRoberts procedure and suprapubic pressure, two with no procedure and three with the corkscrew procedure. CONCLUSION: If all infants > 4,000 g had been delivered by cesarean section, there still would have been 36 cases of shoulder dystocia. If the ultrasonically estimated weight were used to select patients for cesarean section, seven cases would have been diagnosed. To lessen the degree and incidence of fetal injury, labor ward staff are urged to become as familiar as possible with the techniques of freeing the shoulders.

Asphyxia Neonatorum↗