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Results for “LABOR PRESENTATION”

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PubMed1998

Can labor with breech presentation be induced?

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Adult↗
PubMed1977

The effect of prostaglandins on the electromyogram and motility of the monkey uterus and oviduct in late pregnancy and postpartum.

The electromyogram of the monkey (Macaca fuscata fuscata and Macaca mulatta) uterus in labor presents spike bursts which accompany the rising intrauterine pressure. Asynchronous localized electrical activity develops into synchronous activity during the course of labor. The early postpartum uterus shows an irregular pattern or continuous small bursts of spikes. During labor it responds markedly to prostaglandins (PGs); this declines in postpartum. Direct intrauterine injection of PGF2a is effective in the early postpartum. Intravaginal application of PGE2 (5 mg/kg) in late pregnancy induces regular, frequent bursts of spikes and successful delivery. Electrical activity of the oviduct was not affected by PGs except in early postpartum.

Animals↗
PubMed1995

Coping style and preterm labor.

Psychometric tests (State-Trait Anxiety Index and Utrechtse Coping Lijst) were administered to 23 primigravidae hospitalized for preterm labor and to 22 controls in order to investigate whether women with and without preterm labor present a different coping style or (in) effectiveness of this coping and whether the coping style predicts duration of hospitalization and gestational age at delivery. No significant differences in trait anxiety nor in coping style were found between women with and women without preterm labor. However, within the group of women with preterm labor, coping mechanisms are important predictors of course and outcome of the preterm contractions. Palliative coping and social support seeking are protective mechanisms while active coping has an adverse effect upon outcome: an older gestational age at the moment of delivery is for 44% predicted by a higher social support seeking and a lower active coping.

Adaptation, Psychological↗
PubMed1995

Work disability in adults with cystic fibrosis.

Greater numbers of persons with cystic fibrosis (CF) reach adulthood and, therefore, actively participate in the labor force. In this study, we estimated labor force participation rates and determined risk factors for work disability among persons with CF. We recruited 49 (73%) of 67 adults followed at one of two hospital-based CF centers. We ascertained employment history and CF-attributed work disability by structured questionnaire. Independently, we reviewed medical records for demographics and illness severity indicators. We analyzed potential risk factors for work disability by logistic regression analysis. All of those studied reported past or present labor force participation, consistent with high work motivation. Complete cessation of work attributed to CF was reported by 17 (35%; 95% CI, 21 to 49%). Although 23 (47%; 95% CI, 32 to 60%) of those surveyed stated that CF had affected career choice, only nine respondents had ever received career counselling and 16 had ever discussed job choice with their physicians. After adjusting for standard measures of disease severity by multiple logistic regression, age, adult diagnosis of CF, female gender, and single marital status, analyzed as a group, provided significant additional explanatory power to a predictive model of disability risk (model chi square [4 d.f.] = 11.5, p < 0.05). Health care professionals who design interventions targeted at work disability among persons with CF should address demographic factors as well as illness severity and should assess the vocational needs of persons with CF and the potential benefit of career counselling.

Adult↗
PubMed2001

[Acute pulmonary edema caused by tocolytic therapy with salbutamol].

BACKGROUND: Acute pulmonary edema may be induced by beta 2-mimetics used for tocolysis. CASE REPORT: A 41-year-old patient, admitted for preterm labor, presented acute pulmonary edema after parenteral tocolysis using salbutamol in combination with corticosteroid therapy to improve fetal pulmonary maturation. DISCUSSION: The pathogenic mechanism is essentially non-cardiologic. Fluid retention is probably the main cause, potentially worsened by corticosteroid administration. If detected early, pulmonary edema is usually and adequately treated by cessation of beta 2-sympathomimetic therapy, oxygen administration and diuretics. Mechanical ventilation can be required. Cardiac function must be assessed after this complication. In preterm labor, the duration of tocolysis with beta 2-sympatomimetics should be reduced.

Acute Disease↗
PubMed2004

Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor.

OBJECTIVE: Less than 10% of women presenting with preterm contractions progress to active labor and delivery. This study investigates whether cervical length measurements by ultrasound can discriminate between true and false labor in women presenting with threatened preterm labor. METHODS: Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at a median age of 31 (range, 24-35) weeks of gestation. Women presenting in active labor, defined by the presence of cervical dilatation of >or = 3 cm, those with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within 7 days of presentation based on the results of randomized studies on the use of tocolytics in women with preterm labor that reported a prolongation of pregnancy by 7 days. RESULTS: Delivery within 7 days of presentation occurred in 21/253 (8.3%) pregnancies and this was inversely related to cervical length. Receiver-operating characteristics (ROC) curves established a cervical length of 15 mm as the most relevant cut-off level for the prediction of preterm delivery within 7 days. In 217 cases the cervical length was > or = 15 mm and only four of these (1.8%) delivered within 7 days. In the 36 women with cervical length < 15 mm, delivery occurred in 17 (47.2%) within 7 days. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length, contraction frequency at presentation, previous history of preterm delivery and vaginal bleeding. There was no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Similar results were shown in a subanalysis of 162 patients presenting at a gestational age below 32 weeks: 9/19 patients (47.4%) with a cervical length below 15 mm delivered within 7 days compared to 3/143 (2.1%) with a cervical length > or = 15 mm. Univariate as well as multivariate analyses confirmed cervical length to be a significant independent predictor of delivery within 7 days in this population. CONCLUSIONS: Sonographic measurement of cervical length helps to avoid overdiagnosis of preterm labor in women with preterm contractions and intact membranes.

Adolescent↗
PubMedDate not supplied

Bilateral laminotomy and discectomy for segmental lumbar disc disease. Decompression with stability.

A type of bilateral laminotomy with discectomy for segmental lumbar discogenic disease is presented. The procedure includes wide bilateral decompressive laminotomies and radical partial discectomies, partial V-ostectomy of the adjacent spinous processes, partial facetectomies of the inferior and superior articular processes, and foraminotomies as indicated. One hundred patients who underwent this procedure were evaluated by an independent examiner in follow-up an average of six years postoperatively. The patients were evaluated by utilizing a scale which included back and leg pain relief, restriction of physical activities, analgesic use, and return to work. Seventy patients were graded as good, 12 as fair, and 18 as poor. Preoperative factors which were highly significantly correlated with a good postoperative result included occupation other than heavy labor, present employment or less than 12 months of unemployment, unilateral subjective paresthesias, symptoms of spinal claudication, unilateral restriction of straight leg raising, a positive Cram or bowstring test, the severity of the myelographic defect, elevation of spinal fluid protein, and the severity of the disc pathology noted at surgery. Several other preoperative factors were noted to be of somewhat lesser significance and were correlated with a poor surgical outcome, including job-related injury, compensation or litigation, previous unsuccessful surgery, subjective weakness, calf atrophy, and sensory deficit.

Adolescent↗
PubMed2006

Predicting operative delivery.

OBJECTIVE: Unplanned operative delivery (vaginal or abdominal) is associated with maternal anxiety, maternal and neonatal morbidity and increased resource use. We aimed to identify potential predictors for emergency operative delivery. METHODS: This was a prospective observational study of 202 nulliparous women in a tertiary antenatal unit between 36 and 40 weeks' gestation. The assessment included an interview, a vaginal examination for Bishop score (optional), and a translabial ultrasound examination performed with the woman in a supine position and after voiding to determine cervical length, bladder position on Valsalva, and fetal head engagement. Clinical data were obtained from the institutional obstetric database and patient records. RESULTS: In the late third trimester, body mass index (P = 0.016), maternal age at due date (P < 0.0001), history of Cesarean section in first-degree relatives (P = 0.009), Bishop score (P = 0.0004), cervical length (P = 0.001), bladder position on Valsalva (P = 0.003) and head engagement (P < 0.0001) were significantly associated with delivery mode. On multivariate logistic regression analysis, the best model for predicting normal vaginal delivery contained maternal age, history of Cesarean section, Bishop score and bladder position on Valsalva and had excellent ability to discriminate between normal vaginal delivery and operative delivery (c = 0.85). The model with the best ability to discriminate between vaginal delivery and Cesarean section contained the same parameters plus body mass index; this model performed even better (c = 0.87). CONCLUSIONS: Identification of women at increased risk of operative delivery appears feasible. A combination of clinical and ultrasound variables yielded a model that is likely to predict delivery mode accurately in up to 87% of cases. Such a model may become useful as an entry criterion for intervention trials in women at low or very high risk of operative delivery.

Adult↗