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PubMed1986

[Delivery planning and interdisciplinary management of large coccygeal teratomas].

Prenatal sonographic screening and a growing experience of examiners with regard to possible congenital malformations such as large coccygeal teratomas have induced the request for an early interdisciplinary consultation between obstetrician, human geneticist, paediatric surgeon, neonatologist and psychologist. It should aim at a careful information and counselling of the parents with regard to the mode of delivery and possibilities of operative management. The prerequisites for far sighted planning and performance of delivery are demonstrated by the example of large coccygeal teratomas. The availability of equipment, facilities and manpower at the time of delivery guarantees a course of delivery at reduced risk and is, together with the psychological guidance of the parents, a basic element of optimal care for the newborn.

Coccyx↗
PubMed1994

The outcome of fetal myelomeningocele brought to term.

14 years experience with 354 infants born with myelomeningocele are reviewed in view of prelabor and pre-rupture of amniotic membranes vs vaginal delivery or delivery by cesarian section after labor and rupture of amniotic membrane. The apparent lack of effect of severity of impairment determined by prenatal diagnosis on parental decision to carry their baby to term, the negative effect on motor function of kyphos or congenital kyphoscoliosis, the equivocal effect of breech presentation with or without rupture of amniotic membranes and the beneficial effect of prelabor and prerupture of membranes delivery of selected infants is discussed. The need for further multiple center, collaborative study to identify the contribution of a number of factors influencing the outcome of fetuses diagnosed as having myelomeningocele is emphasized.

Breech Presentation↗
PubMed1994

Does caesarean section delivery improve neurological outcome in open spina bifida?

The antenatal diagnosis of fetuses with myelomeningocele (MMC) has focused the attention of those involved in the perinatal care on caesarean section delivery as a possible method of preserving neurological function. In this paper 25 infants with MMC were studied, 10 delivered by pre-labour caesarean section (PL C/S), and 15 by other methods. No difference in motor function was observed post natally with 50% of each group having neurological levels below L3. The PL C/S group was more heterogeneous. The feasibility of selecting a group of less impaired fetuses with good in utero leg movements for PL C/S in order to preserve neurological function depends on the ability of fetal USS to predict post natal neurological function. This preliminary report leaves unanswered the question whether C/S delivery improves neurological outcome in selected cases of open spina bifida.

Cesarean Section↗
PubMed2001

Vaginal birth after cesarean among women with gestational diabetes.

OBJECTIVE: We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December 31, 1999. One hundred fifty-six women with gestational diabetes were matched with 272 control subjects. Data were analyzed with the Student t test, chi2 analysis, and the Fisher exact test. RESULTS: The parities of the women with gestational diabetes and the control subjects were similar, with most having had only one previous pregnancy. Women with gestational diabetes were significantly older than control subjects and more likely to be white or Hispanic. Women with gestational diabetes who attempted a trial of labor were significantly more likely than control subjects to be delivered abdominally. Women with gestational diabetes who had a successful vaginal birth after cesarean were significantly more likely than control subjects to have an operative delivery with forceps or vacuum. CONCLUSION: Women with gestational diabetes are less likely than those without diabetes to have a successful trial of labor. Women with gestational diabetes considering vaginal birth after cesarean should be appropriately counseled about the risk of attempting a trial of labor after previous cesarean delivery.

Adult↗
PubMed2002

The prediction and prevention of intrapartum fetal asphyxia in preterm pregnancies.

OBJECTIVE: This study was undertaken to examine the contribution of electronic fetal heart rate monitoring in the prediction and prevention of intrapartum fetal asphyxia in the preterm pregnancy. STUDY DESIGN: The outcome of 40 pregnancies with biochemically confirmed intrapartum fetal asphyxia (ie, an umbilical artery base deficit >12 mmol/L) was examined. This included 20 pregnancies that were delivered abdominally matched with 20 pregnancies that were delivered vaginally. Antepartum and intrapartum clinical risk factors and newborn complications were documented. The interpretation of the fetal heart rate record as determined by the responsible clinicians was recorded. Fetal asphyxia was classified as mild, moderate, or severe on the basis of an umbilical artery base deficit of >12 mmol/L and newborn encephalopathy and other organ system complications. RESULTS: Fetal asphyxia was classified as mild in 21 pregnancies and as moderate or severe in 19 pregnancies. The fetal heart rate record was predictive of fetal asphyxia in 27 pregnancies and nonpredictive in 11 pregnancies. The predictive fetal heart rate record was the primary indication for intervention in 21 of the 24 pregnancies that were delivered by cesarean delivery in the first stage or operative vaginal delivery in the second stage of labor. Newborn outcome may have been influenced by intervention and delivery because of a predictive fetal heart rate record in 10 pregnancies with mild fetal asphyxia and in 9 pregnancies with moderate or severe fetal asphyxia. CONCLUSION: Electronic fetal monitoring is a useful screening test for the prediction of intrapartum fetal asphyxia in the preterm pregnancy. A predictive fetal heart rate record was the principle indication that led to intervention and delivery. A prediction of fetal asphyxia that leads to intervention and delivery may prevent or modify moderate or severe newborn morbidity as the result of fetal asphyxia.

Cesarean Section↗
PubMed2002

Outcome after elective labor induction in nulliparous women: a matched cohort study.

OBJECTIVE: To determine whether elective induction of labor in nulliparous women is associated with changes in fetomaternal outcome when compared with labor of spontaneous onset. STUDY DESIGN: All 80 labor wards in Flanders (Northern Belgium) comprised a matched cohort study. From 1996 through 1997, 7683 women with elective induced labor and 7683 women with spontaneous labor were selected according to the following criteria: nulliparity, singleton pregnancy, cephalic presentation, gestational age at the time of delivery of 266 to 287 days, and birth weight between 3000 and 4000 g. Each woman with induced labor and the corresponding woman with spontaneous labor came from the same labor ward, and they had babies of the same sex. Both groups were compared with respect to the incidence of cesarean delivery or instrument delivery and the incidence of transfer to the neonatal ward. RESULTS: Cesarean delivery (9.9% vs 6.5%), instrumental delivery (31.6% vs 29.1%), epidural analgesia (80% vs 58%), and transfer of the baby to the neonatal ward (10.7% vs 9.4%) were significantly more common (P <.01) when labor was induced electively. The difference in cesarean delivery was due to significantly more first-stage dystocia in the induced group. The difference in neonatal admission could be attributed to a higher admission rate for maternal convenience when the women had a cesarean delivery. CONCLUSION: When compared with labor of spontaneous onset, elective labor induction in nulliparous women is associated with significantly more operative deliveries. Nulliparous women should be informed about this before they submit to elective induction.

Adult↗
PubMed2001

Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging.

Neonatal upper cervical spinal cord injury is associated with rotational forceps delivery and presents with quadriparesis and diaphragmatic paralysis. The underlying pathology determines neurologic outcome but is difficult to assess clinically or with simple radiographic techniques. We report 4 cases in which early magnetic resonance imaging demonstrated the extent and severity of the injury and guided management.

Cervical Vertebrae↗
PubMed2004

How long does it take to perform an operative vaginal delivery?

We set out to see how long it takes to achieve an operative vaginal delivery in normal practice. This was a prospective survey, conducted in a major and well-staffed British maternity unit over 1 month. Sixty-two assisted vaginal deliveries occurred in the month of the study. Thirteen data collection sheets were spoiled or could not be confirmed and were discarded before analysis. Therefore the remaining data are based on 49 deliveries. The main outcome measure was the time interval between the decision to assist the vaginal delivery and the delivery. Fifty per cent of babies were delivered within 18 minutes once the decision to act had been made (range 6-85 minutes). If the primary indication for delivery was an abnormal CTG the median time was 16 minutes (mean 20 minutes). Any legal claim based on the assumption that a reasonably competent obstetrician should deliver a baby within 15 minutes cannot be supported by scientific data.

Delivery Rooms↗
PubMed2006

Understanding operative intervention in childbirth: a patient perspective.

A study was undertaken to ascertain patients' understanding of the operative interventions in labour and to assess follow-up by the operator. A total of 200 consecutive women who had undergone caesarean section or instrumental delivery were selected. These women were questioned postoperatively. Questions were asked to ascertain the patients' understanding of the procedure and to assess follow-up by the operator. Seven patients had a forceps delivery, 64 had a ventouse delivery and 129 had a caesarean section. The majority of patients felt that the reason for the operative delivery had been explained to them at delivery and that they fully understood the need for this intervention. A total of 26 women were not seen postoperatively by the doctor who delivered them. Women who underwent forceps or ventouse delivery were less likely to be seen post-delivery, although this difference did not reach statistical significance.

Adolescent↗
PubMed1997

Risk factors and prognosis for brachial plexus injury and clavicular fracture in neonates: a prospective analysis from the United Arab Emirates.

The purpose was to identify risk factors and document the incidence and prognosis for brachial plexus palsy (BPP) and clavicular fracture (CF) among consecutive hospital liveborn (LB) infants in the United Arab Emirates. During a 2-year period, all hospital-born infants were examined twice by paediatricians before discharge and those found to have BPP or CF were evaluated and followed up by an orthopaedic surgeon. Each clavicular fracture was confirmed radiologically. For the assessment of risk factors, three controls were selected for each case of BPP or CF. Of the 9231 LB, 27 (2.9/1000) had BPP while 24 (2.6/1000) sustained CF. After controlling for potential confounding variables, shoulder dystocia (SD), fetal macrosomia (birthweight > 4000 g), instrumental vaginal delivery and diabetes remained risk factors for BPP while only fetal macrosomia and instrumental delivery increased the risk of CF. The frequency of these risk factors was higher than that reported from the West. Infants with BPP had a higher incidence of SD (p = 0.0001) and tended to be heavier (p = 0.052) than those with CF. All infants with CF recovered while 20% of those with BPP had moderate to severe residual disabilities. This study highlights geographic differences in risk factors for BPP and CF and the possible contribution of BPP to morbidity in infancy. Early recognition of fetal macrosomia and improved management of SD and maternal diabetes are necessary to reduce the incidence of BPP and CF as well as morbidity from BPP in this community.

Adult↗
PubMed1991

Relationships between intellectual control beliefs and psychometric intelligence in adulthood.

This longitudinal study examined perceived control of intelligence and its relationship with intellectual performance. A large sample (ages 43-84) was administered the short form of Lachman's PIC and psychometric tests of eight intellectual abilities in both 1985 and 1987. There were significant cross-sectional age differences in the three scales: Internal (INT), Powerful Others (POW), and Chance (CHA). The three scales correlated with all intellectual abilities, with relationships being largest for POW. The PIC scales showed lower test-retest correlations than the intelligence tests. Individual differences in change in POW and CHA were also correlated with prior levels of psychometric intelligence, and path analyses suggested a small but significant prediction of change in POW by prior levels of intelligence.

Adult↗
PubMed2001

Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage.

BACKGROUND: Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first randomized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage. METHODS: Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999. They were randomized to group 1: misoprostol; and group 2: expectant management. Women in the misoprostol group received vaginal misoprostol 400 microg on days 1, 3 and 5. The expectant group was followed up according to the same schedule. Suction evacuation was performed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15. RESULTS: Fifty-nine women completed the trial. Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful. The incidence of side-effects was comparable between the two groups. Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding. The mean duration of vaginal bleeding was similar for both groups (14.6 days in the misoprostol group versus 15.0 days in the expectant group). The successful rate in the misoprostol group was significantly higher than that of the expectant group (83.3 versus 48.3%, P < 0.05). CONCLUSION: We recommend repeated vaginal misoprostol 400 microg given on days 1, 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage.

Abortion, Spontaneous↗