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Penetrating ocular injury with a fetal scalp monitoring spiral electrode.

PURPOSE: To report a penetrating ocular injury resulting from inadvertent placement of a fetal scalp monitoring spiral electrode into the right eye of a preterm male with a face presentation. METHODS: Case report and review of the literature. RESULTS: A spiral electrode was screwed clockwise into the right eye, tearing the inferior retina and creating two inferior iridotomies. Severe myopic astigmatism resulted from gradual lens dislocation combined with elongation of the eye. Despite persistent occlusive therapy and aggressive optical correction, before and after lensectomy at age 3 years, visual acuity was only 20/200 at age 8 years. CONCLUSIONS: Although complications from spiral monitoring electrodes are uncommon, this case emphasizes that before inserting a spiral monitoring electrode during labor, face presentation must be excluded to prevent inadvertent ocular injury.

Electrodes↗

Modern indications for cesarean section.

Total cesarean section rates and rates of various indications for primary cesarean section were reviewed for four yearly periods during the past decade. The time periods studied were chosen to follow the introduction of new obstetric practices and technologic advances in monitoring fetal condition. The total cesarean section rate increased from 6.8% to 17.1% during this time. The most common indication for primary cesarean section was cephalopelvic disproportion, which represented approximately 40% of cases during each study period. Primary cesarean section for fetal distress increased to 28.2% but has decreased over the past 2 years to a present rate of 11.7%. Primary cesarean section for breech presentation increased from 12.3% to 21%. From the perspective of this review a total cesarean section rate of 15% is predicted for the future.

Cesarean Section↗

Management of high-order multiple gestation.

High-order multiple gestation presents unique challenges to the clinician to obtain the best possible outcome. An aggressive proactive approach works best compared with a wait-and-treat strategy when complications occur. Frequent ultrasound evaluations, fetal fibronectin testing, and contraction monitoring are important diagnostic tools. Aggressive weight gain, bed rest, and relaxation techniques are important interventions. Tocolytic drugs are used to prevent preterm labor, and aggressive dosing of MgSO4, terbutaline pumps, and oral agents are advocated to treat preterm labor. Outcome is generally good with high-order multiple gestation with this management protocol.

Female↗

Critical remarks on external cephalic version under tocolysis. Report on a case of antepartum fetal death.

SALING and MULLER-HOLVE recently proposed an improved method of external cephalic version brought about a renewed interest in this obstetric procedure. In spite of the undisputed advantages in individual cases we posed the following questions: 1. The extent of the decreased cesaerean section rate 2. The fetal risk We estimate a decrease of cesarean sections by about 1.5% under the assumption that a breech presentation in primiparae is an indication of cesarean section and that 70% of the version attempts would be successful. The estimate includes some cases of multi-parae breech presentations which would have been operated without external version. The resulting decrease of the cesarean section rate is generally not very important and has a greater impact only in individual cases. We have some misgivings about the fetal risk. We report here on a case of intrauterine fetal death after failed external version. A 28 year-old primiparae without known pregnancy complications was admitted with a breech presentation in the 37th week of gestation. The biparietal diameter of the fetal head was appropriate and the placenta was posterior. Cardiotocogram before and after the unsuccessful version were in part misinterpreted. Seven hours after the version the fetal death was confirmed. Histological examination of the placenta showed a severe dissociated maturation disturbance in addition to a 10 X 8 cm large abruptio which had not been noted clinically. A prediabetes was suspected. The fetus itself showed no anomalies. This was interpreted as a severely placentogenically prestressed infant and prediabetes. The extent of the placental disturbance was unknown and had not been appreciated from the ultrasound examination. The placenta had acute infarcts and a circumscript abruption. The CTG was misinterpreted in part. In another case of version the postoperative cardiotocogram showed pathologic patterns. The birth occurred three weeks later without problems with a well child and an umbilical artery pH of 7.31...

Abruptio Placentae↗

Obstetrician's view of the physiology of equine parturition and dystocia.

The author reviews 40 years of clinical experience including more than 1000 cases of dystocia in mares of different breeds. The high incidence of stillbirth and perinatal mortality of the foal, severe lesions of the genital tract developing during foaling and in the early post partum period are discussed and suggestions made for their prevention and treatment. The advantages of partial embryotomy to avoid unnecessary caesarean sections are emphasised. Special attention is given to the causes of and approach to cases of prolonged gestation; to dystocia caused by retroversion of preparturient torsion of the uterus; and to transverse presentation developed from bicornual pregnancy, regarded as the most important indication for caesarean section. Recommendations are proposed to improve the results of caesarean section for the mare and foal.

Animals↗

Neurology and behaviour of newborn infants delivered by vacuum extraction on maternal indication.

23 full-term neonates delivered by vacuum extraction (VE) on maternal indication (primary or secondary uterine inertia) but with no sign of fetal asphyxia and a control group of 16 infants were studied. The infants were examined on the 1st and 5th days after birth with the Brazelton Neonatal Behavioural Assessment Scale and by a standardized neurological examination. On day 1 the VE-infants showed lower visual and auditory responsiveness in the behavioural assessment, and fewer optimal responses in the neurological examination than did the controls. Obstetrical factors such as abnormal presentation, long duration of the second stage of labour, and long duration of VE (greater than or equal to 15 minutes) may explain the differences. The differences between the groups had largely disappeared by day 5.

Child Behavior↗

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Cesarean Section↗

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