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At least 1,801 records · Page 100Linked to original sources
PubMed1983

Outcomes of three birthing rooms.

For women who are prescreened to be at low risk, the birthing room located in a hospital can provide a home-like environment as well as proximity to the regular obstetrical unit in case of an unforeseen complication. Charts of 356 pairs of infants and mothers who were admitted to birthing rooms at three different hospitals were reviewed. The average age of the mother was 25.9 years. Approximately 20 percent of the women had complications requiring their transfer from the birthing room. Fifteen required a cesarean section. The mean Apgar scores of infants born to all women admitted to the birthing room (including those who were subsequently transferred) were 7.7 at one minute and 8.8 at five minutes. Neonatal complications included meconium aspiration (1), sepsis (1), a question of sepsis (1), congenital heart disease (1), and transient tachypnea of the newborn (1). Four infants and one mother required readmission. Although mothers were prescreened to be at low risk, complications did arise for both mother and infant that made proximity to the regular obstetrical and neonatal units advantageous.

Adult↗
PubMed1982

Reported sexual behavior in late pregnancy. Selected associations.

The time intervals prior to delivery both for the last reported sexual intercourse and for the last reported orgasm were considered in terms of several variables in 413 puerperas. Although there were no significant differences in the reported time of last intercourse in terms of any of the demographic factors studied, orgasm in the absence of intercourse (reported events within seven days of delivery) was relatively more common and intercourse in the absence of orgasm relatively less common in study subjects with more years of formal education (p less than 0.01). Reported sexual behavior did not differ in respect to the length of gestation at delivery, selected pregnancy complications or the immediate condition of the newborn.

Coitus↗
PubMed1994

[Non-recognition of a second fetus in a recumbent cow during veterinary obstetrical assistance (expert opinion)].

The objective of the expert opinion presented in this paper is the missing of a second fetus after veterinary obstetrical assistance in a downer cow. The necessity of a thorough examination after obstetrical manipulation is stressed with special reference to problems occurring in recumbent cows. In addition, possible complications after inappropriate removal of retained placental fetal membranes are discussed.

Animals↗
PubMed1993

A survey of patients with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is an inherited disorder of collagen biosynthesis. Nine types of the disorder are now recognized. A survey of 151 EDS patients showed a high percentage of the patients were classified as having Types I through IV. Bracing and fusion appear to be the most commonly used methods of orthopedic care. Surgical complications were common. The orthopedist was often the first practitioner to diagnose and treat the patient with EDS. A fundamental understanding of this complex disorder and its varied manifestations is essential to prevent major life-threatening complications.

Adult↗
PubMed2004

Independent predictors of cesarean delivery in women with diabetes.

OBJECTIVES: To identify independent risk factors for Cesarean delivery in women with pregnancy complicated by diabetes. METHODS: Retrospective analysis of pregnancies from 5735 diabetic women delivering liveborn infants. Maternal demographic, medical, obstetric historical factors and index pregnancy obstetric, glycemic and neonatal outcome parameters were evaluated for association with Cesarean delivery after a trial of labor. Individual risk factors were analyzed for association by chi2 and ANOVA. Independent predictors of Cesarean delivery and adjusted relative risk (RR) were identified by stepwise logistic regression. RESULTS: Trial of labor was permitted in 90.8% and 59.4% of women without (n = 4643) and with prior Cesarean delivery (n = 1092) and was successful in 85.2% and 56.9%, respectively. Eleven independent predictors were found. Five were related to obstetric history and maternal age: prior Cesarean delivery (RR 5.34, 95% CI 3.94-7.25), no prior live birth (RR 3.17, 95% CI 1.98-5.07), no prior vaginal delivery (RR 2.28, 95% CI 1.50-3.44), prior stillbirth (RR 1.71, 95% CI 1.09-2.68%) and maternal age > or = 35 years (RR 1.53, 95% CI 1.20-1.93). Two were related to the severity of diabetes at entry to diabetes care: requiring insulin (RR 1.53, 95% CI 1.20-1.93) and highest fasting plasma glucose level (RR 1.04, 95% CI 1.01-1.07). Two were related to obstetric factors: pre-eclampsia/hypertension (RR 2.56, 95% CI 2.00-3.27) and labor induction (RR 3.32, 95% CI 2.70-4.10). The remaining two were birth weight (per 250 g, RR 1.12, 95% CI 1.09-1.17) and pre-delivery body mass index (RR, 1.03, 95% CI 1.00-1.05). CONCLUSION: The majority of predictors were not modifiable, relating to obstetric history, maternal age and diabetes severity. Possible modifiable interventions to avoid/improve labor induction, and decrease birth weight and maternal weight gain might decrease risk of Cesarean delivery. Future studies must address these multiple predictors.

Adult↗
PubMed2005

Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study.

OBJECTIVE: The study was aimed to identify obstetric risk factors for early postpartum hemorrhage (PPH) in singleton gestations and to evaluate pregnancy outcome. STUDY DESIGN: A comparison between consecutive singleton deliveries with and without early PPH was performed. Deliveries occurred during the years 1988-2002 in a tertiary medical center. A multivariate logistic regression model was constructed in order to define independent risk factors for PPH. RESULTS: Postpartum hemorrhage complicated 0.4% (n = 666) of all deliveries enrolled in the study (n = 154 311). Significant risk factors for PPH, identified using a multivariable analysis, were: retained placenta (OR 3.5, 95%CI 2.1-5.8), failure to progress during the second stage of labor (OR 3.4, 95%CI 2.4-4.7), placenta accreta (OR 3.3, 95%CI 1.7-6.4), lacerations (OR 2.4, 95%CI 2.0-2.8), instrumental delivery (OR 2.3, 95%CI 1.6-3.4), large for gestational age (LGA) newborn (OR 1.9, 95%CI 1.6-2.4), hypertensive disorders (OR 1.7, 95%CI 1.2-2.1), induction of labor (OR 1.4, 95%CI 1.1-1.7) and augmentation of labor with oxytocin (OR 1.4, 95%CI 1.2-1.7). Women were assigned into three different groups according to the assessed severity of PPH, assuming that the severe cases were handled by revision of the birth canal under anesthesia, and the most severe cases required in addition treatment with blood products. A significant linear association was found between the severity of bleeding and the following factors: vacuum extraction, oxytocin augmentation, hypertensive disorders as well as perinatal mortality, uterine rupture, peripartum hysterectomy and uterine or internal iliac artery ligation (p < 0.001 for all variables). CONCLUSION: Hypertensive disorder, failure to progress during the second stage of labor, oxytocin augmentation, vacuum extraction and LGA were found to be major risk factors for severe PPH. Special attention should be given after birth to hypertensive patients, and to patients who underwent induction of labor or instrumental delivery, as well as to those delivering LGA newborns.

Arteries↗
PubMed2001

Uterus inferior segment compression as a clinical test for diagnosing nuchal cord.

To investigate sensitivity, specificity, positive and negative predictive values and accuracy of uterus inferior segment compression (UISC) as clinical test for diagnosing nuchal cord. This test is used empirically. The clinical test was applied to 214 pregnant women in the first phase of delivery with single cephalic fetuses. The main observation was deceleration of the fetal heart rate by performing the clinical test in the presence of nuchal cord. Statistic analysis was done by chi2-test. The results were: sensitivity 35.7%, specificity 84.8%, positive predictive value 45.4%, negative predictive value 78.8% and accuracy 71.9% (chi2=10.66, p=0.0011). The UISC could be used as a tool in the initial exploration of the term pregnant woman in labor without complications to rule out the presence of nuchal cord. When the UISC test is positive, close vigilance is recommended along with the availability of an emergency team in case of fetal distress.

Adolescent↗
PubMed1997

Pregnancy, delivery and infancy complications and attention deficit hyperactivity disorder: issues of gene-environment interaction.

We evaluated the role of pregnancy, delivery, and infancy complications (PDICs) in the etiology of attention deficit hyperactivity disorder (ADHD) and addressed issues of comorbidity and familiarity by testing multiple hypotheses. Subjects were 6-17-year-old boys with DSM-III-R ADHD (n = 140) and normal controls (n = 120) and their first-degree biologic relatives. Information on PDICs was obtained from mothers in a standardized manner blind to the proband's clinical status. Using linear and logistic regression models, a positive association was found between ADHD and PDICs in the probands. Additionally, PDICs were associated with the correlates of ADHD (i.e., impaired cognitive functioning and poor school performance). Moreover, it was those specific complications that reflect chronic exposure, such as maternal bleeding, smoking, family problems, and illicit drug use during pregnancy that accounted for these findings. No interaction between genetic factors and PDICs were found. Our findings add to the literature supporting an association between ADHD and PDICs. Our results may help clinicians focus on particular complications rather than the wide range of possible perinatal complications.

Adolescent↗
PubMed1995

Control of gestational diabetes.

OBJECTIVE: The purpose of the study was to determine the best regimen for metabolic control of gestational diabetes. METHODS: A prospective study was conducted over a period of 5 years in 355 diabetic women delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, between January 1987 and December 1991. The patients were divided into three groups according to their mean plasma glucose levels during pregnancy: good control was defined as a mean plasma glucose level of less than 120 mg/dl (group A); moderate control as a mean plasma glucose level between 120 and 140 mg/dl (group B); and poor control as a mean plasma glucose level in excess of 140 mg/dl (group C). The t-test was used for statistical analysis. RESULTS: Antenatal and neonatal complications were much higher in groups B and C than in group A, the overall complication rate being five times higher in group C than in group A. CONCLUSION: The data indicate that good glycemic control is one determinant of maternal and fetal complications in pregnancies complicated by gestational diabetes.

Adolescent↗
PubMed1982

Fetal lactic acidosis with epidural anesthesia.

Three hundred thirty-six consecutive cesarean deliveries performed under epidural anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall in blood pressure following administration of epidural anesthesia. An additional 24% required ephedrine, a vasopressor with predominantly beta activity, when other corrective measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one percent of all elective repeat cesarean sections were treated wih ephedrine because of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean section were divided into ephedrine-treated and untreated groups. There were no differences in Apgar scores among infants of both groups. Fetal acidosis was proportional to the severity of hypotension and the ephedrine dose. The metabolic abnormalities were most pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas PO2 and PCO2 reverted toward normal values. The hypoperfusion of the intervillous space was the most likely cause of the observed significant umbilical venous and arterial lactic acidosis. Maternal hypotension remains a significant problem complicating conduction anesthesia.

Acidosis↗
PubMed1997

Vaginal birth after cesarean delivery: an admission scoring system.

OBJECTIVE: To develop a scoring system to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHODS: Trial of labor was attempted in 5022 patients who were assigned randomly to score derivation and score testing groups. Multivariate logistic regression modeling was used in the score derivation group to develop a predictive scoring system for vaginal birth. The scoring system was then applied to the testing group to evaluate its predictive ability. RESULTS: Five variables significantly affected the mode of birth and were incorporated into a weighted scoring system. Rates of successful vaginal birth after cesarean ranged from 49% in patients scoring 0-2 to 95% in patients scoring 8-10. Increasing score was associated linearly with increasing probability of vaginal birth after cesarean. CONCLUSION: Increasing scores correlate with increasing probability of vaginal birth after cesarean. The admission vaginal birth after cesarean scoring system may be useful in counseling patients regarding the option of vaginal birth or repeat cesarean delivery. This information could be particularly valuable for the patient who opts for trial of labor but has second thoughts about her mode of birth when labor begins.

Adult↗
PubMed1989

[Overweight newborn infants--incidence, causes and clinical significance].

A retrospective study of 7711 births revealed 741 (9.6%) overweight (greater than 4,000 g) neonates. Statistical analysis shows, that neonatal macrosomia closely correlates with maternal age, parity, and weight. The pathogenesis of neonatal macrosomia appears to be influenced primarily by genetic factors. 19% of the cases show a pathological oral glucose tolerance test and/or hypertension, whose role in the development of overweight neonates has yet to be determined. With the exception of shoulder dystocias, postpartal atonia and hyperbilirubinaemia, the rate of obstetric or paediatric complications was not increased compared to the control group. The delivery of overweight neonates of non-diabetic mothers does not appear to carry an increased risk of intra- and postpartal complications.

Birth Weight↗
PubMed2003

Obstetric management of the patient with spinal cord injury.

Pregnancies in spinal cord-injured patients present unique clinical challenges to obstetric providers. Spinal cord injury (SCI) alters the function of multiple organ systems, and chronic medical conditions are extremely common in this patient population. Autonomic dysreflexia (ADR) is a potentially life-threatening complication of SCI, usually involving patients with spinal cord lesions at or above the T6 level. Intrapartum care of women with SCI is particularly complicated, and labor is the period during which ADR is most likely to arise. A multidisciplinary team in a unit capable of invasive hemodynamic monitoring should deliver these patients. Epidural anesthesia should be administered early in labor to prevent ADR. If proper precautions are taken, most patients with SCI will have successful vaginal deliveries at term.

Autonomic Dysreflexia↗
PubMed1985

[Safety of term birth and cesarean birth rates].

This was a parallel of the rate of caesarean section and neurological morbidity of the term newborn. This study was performed on all infants born at a gestational age of 37 weeks or greater in 1981 and 1982 at the Baudelocque Maternity Hospital. The results show a stable caesarean section rate during these two years: 21% in 1981, 20% in 1982; as for the safety of term birth there was only one case of perinatal insult during a vaginal birth responsible for cerebral dysfunction of moderate degree. There was a 18% operative maternal morbidity and there were no deaths. We concluded that a caesarean section rate of 20% in a University Hospital is justified by the virtual absence of neonatal morbidity with an acceptable maternal risk. This rate should not increase. The possible ways of decreasing this rate, while maintaining neonatal safety, must be studied. The original aspect of this work concerns the monitoring of the caesarean section rate by the incidence of neurological complications of all term births during a fixed period of time.

Cesarean Section↗

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