[The influence of fetal measurements on the duration of labor].
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Congenital abnormalities of the aortic arch may lead to signs and symptoms of tracheal and esophageal obstruction secondary to a restrictive vascular ring. There are many case reports and monographs concerning the surgical management of dysphagia lusoria. This case provides the first example of long-term follow-up of surgical intervention for relief of dysphagia lusoria. A 45-year-old laborer presented with a several year history of episodic bilateral blindness and a more recent onset of "drop attacks." Notably this patient had presented at the age of 18 months with difficulty breathing and eating since birth. The patient also had frequent upper respiratory infections and episodes of pneumonia. Workup revealed a right-sided aortic arch with a left ligamentum arteriosum. When he was first seen in our clinic, history and physical examination revealed claudication and diminished pulses in the left upper extremity. Arteriography and duplex studies confirmed reversal of flow in the patient's left vertebral artery. The arteriogram demonstrated the presence of a right-sided aortic arch and descending aorta along with the proximal stump of the previously ligated left subclavian artery. He underwent left carotid to left axillary artery bypass for the treatment of symptomatic subclavian steal syndrome. His symptoms have resolved with return of antegrade vertebral flow and the presence of normal pulses in the left arm. Congenital aortic abnormalities that lead to tracheal and esophageal compromise are numerous and varied. Surgical management requires a thorough understanding of the person's anatomy and preoperative planning. The life expectancy of patients with dysphagia lusoria necessitates consideration of the long-term consequences of surgical intervention.
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Fetal heart rates in the range of 100 to 119 beats per minute have been defined as moderate bradycardia. Twenty-five of 1,386 patients monitored during a 1 year period have manifested persistent moderate bradycardia. Moderate bradycardia is apparently related to fetal head compression, often in situations of relative cephalopelvic disproportion. It is alleviated by rotation of the vertex and does not appear to adversely affect the newborn infant.
The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.
The lateral Sims' position was evaluated for routine use in vaginal deliveries. The study demonstrates that delivery in the lateral Sims' position is practical and easily mastered; most easily applied for spontaneous or uncomplicated outlet forceps delivery; of special advantage in breech deliveries, congestive heart failure, hip joint restriction, and leg varicosities; and well accepted by women looking for a less restricted and more natural delivery experience.
The history, physiology, pharmacology, and clinical application of fetal breathing are reviewed. Early optimism that measurements of fetal breathing would aid in perinatal management decisions has remained unfulfilled. Problems to be overcome include standardization of technique and measurement parameters and allowance for physiologic variations. Recent research developments indicate that the likely role of fetal breathing in perinatal medicine will be in conjunction with other established tests of fetal health.