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PubMed2005

Labor with abnormal presentation and position.

Abnormal presentation and position are encountered infrequently during labor. Breech and transverse presentations should be converted to cephalic presentations by external cephalic version or delivered by cesarean section. Face, brow, and compound presentations are usually managed expectantly. Persistent occiput transverse positions are managed by rotation to anterior positions and delivered as such. Occiput posterior positions can be delivered as such or rotated to occiput anterior positions. As with any position or presentation, an obstetrician should not hesitate to abandon any rotational or operative vaginal procedure and proceed to cesarean delivery if rotation or descent does not occur with relative ease.

Breech Presentation↗
PubMed1989

Epithelioid hemangioendothelioma of the external iliac vein: a primary vascular tumor presenting as traumatic venous obstruction.

A 32-year-old man employed as a laborer presented with the signs and symptoms of iliofemoral venous obstruction of 1 months' duration. Results of initial phlebography from the ankle to the femoral area were normal. No iliac vein anatomy was seen. This led to a group of tests directed toward neuromuscular function, which were unrewarding. On referral to our institution a noninvasive venous vascular laboratory examination was performed, which clearly indicated iliac vein obstruction/stenosis, with a normally patent distal venous system. Subsequent repeat phlebography, including direct femoral vein injection, visualized a mass lesion partially occluding the iliac vein. This lesion was treated with primary excision and segmental venous replacement with an interposition graft of autogeneous internal jugular vein. The excised lesion proved to be an epithelioid hemangioendothelioma of the iliac vein.

Adult↗
PubMed1982

The monitoring of labor by telemetry.

Telemetry and conventional cardiotocography were compared by monitoring the labor of 60 patients with an uneventful pregnancy and delivery in the 38th-42nd week of pregnancy. 31 patients were monitored by telemetry and 29 by cardiotocography. The patients were matched for age (+/- 5 years), duration of pregnancy (+/- 7 days) and parity (I or II). The husband attended labor and delivery in 42% of the cases in the telemetry group and in 59% of the cases in the control group. Induction of labor by amniotomy was performed in 32% of the cases in the telemetry group and in 24% of the cases in the cardiotocography group. The patients monitored subjective pain every half hour during the opening phase. The telemetric patients were encouraged to sit or walk during the first stage. No maternal or fetal complications occurred. All infants were born in good condition with APGAR scores greater than or equal to 7 recorded at one and five minutes. There were 4 operative deliveries in the telemetry group and 5 in the control group. Indications for these were maternal or uterine exhaustion with the exception of two control patients where fetal asphyxia was suspected. The duration of the first stage of labor did not differ significantly between the telemetry and the cardiotocography groups. The telemetric patients received less analgesics than the controls but this difference was not significant. In spite of less analgesia in the telemetry group, the secondparas of the telemetry group experienced significantly less (p less than 0.01) labor pain than the controls. In addition, the secondparas of the telemetry group considered the present labor less painful than the previous one significantly more often than the controls. Among the primiparous patients there was no difference in the amount of pain experienced by the patients.

Adult↗
PubMed1989

Fetal and maternal oxytocin in human parturition.

Measurements of oxytocin in maternal and fetal circulation during human labor are reviewed and related to known changes in uterine oxytocin sensitivity during pregnancy and labor. It is concluded that oxytocin is secreted in short-lasting spurts; therefore levels measured with infrequent intervals do not give adequate information on the amounts of oxytocin secreted during labor. Presently, there is little evidence for an increased maternal secretion rate of oxytocin at the onset of labor, but during labor a progressive increase occurs, with a maximum at the expulsive phase. Fetal secretion rate also increases markedly during labor, but the timing of this increase is still unknown. The dramatic increase in human uterine oxytocin receptors at term makes the uterus responsive to very small amounts of oxytocin. Hence, an increased oxytocin secretion rate is not a necessary prerequisite for oxytocin-stimulated contractions during labor. Evidence from oxytocin receptor blockade and suppression of oxytocin secretion supports the concept that oxytocin is an important stimulus for uterine contractions in early human labor.

Female↗
PubMed1997

Pain management for labor and delivery in the 90s.

Although variable, labor pain is among the most severe of pain syndromes, and has been described as severe to excruciating in 50 to 70 percent of primiparas. "Twilight sleep" or amnesia was commonly used in the first half of this century via potent intramuscular, intravenous and inhalational agents. Subsequently, epidural anesthesia, first caudal then lumbar was used which offered superior pain relief without clouding the sensorium. However, epidurals with local anesthetics also contributed to dense sensory and motor blocks which are not necessary for labor. Presently, both spinal and epidural opioids are used along with decreasing doses of local anesthetics, rendering the laboring patient a relatively pain-free labor but allowing her more mobility and control of her environment.

Analgesia, Epidural↗