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PubMed1984

[Inguinal hernia in women: a complication of pregnancy or labor. Apropos of 160 cases of surgically treated hernias].

The authors undertook a computerised retrospective study of 10 years of hernia surgery. Analysis of the specific characteristics of hernias in women provided numerical data concerning a number of classical data and in particular revealed the role of multiple gestation (more than 3 pregnancies) in the aetiology of inguinal hernias. Results of different surgical techniques are reported: herniorrhaphy procedures (e.g. the MacVay operation which should perhaps be abandoned to give way to the Shouldice procedure) retain a wide role in women. The Dacron mesh prosthesis, with an additional risk of infection of 0.5 to 3.7% offers long term reliability (98.5% cure rate) which cannot be hoped for with any herniorrhaphy procedure when repairing the most difficult hernias. The authors suggest that gynaecologists and obstetricians should continue the study or physiopathological mechanisms causing hernias since they alone would be capable of undertaking such a prospective study.

Adolescent↗
PubMed1988

Who is the elderly primigravida in Nigeria?

A retrospective study of 792 primigravidae, divided into four age-groups, was made in order to detect which group showed features of the elderly primigravida. Adolescent primigravidae showed significantly highest incidences of pre-eclampsia, anemia, premature labor and cephalopelvic disproportion. The 20-24 year age-group showed the least incidence of pregnancy and labor complications. The 25-29 year age-group showed significantly increased incidences of uterine fibroids, pre-eclampsia, post-term pregnancy, premature labor, slow labor, fetal distress, failed induction, vacuum and cesarean section deliveries, when compared with the 20-24 year age-group. Most of the complications in the 25-29 year age-group were continued into 30-34 years. A woman 25 years and above in her first pregnancy in Nigeria should be termed "elderly primigravida".

Adult↗
PubMedDate not supplied

Use of intrathecal analgesia in a rural hospital. Case studies.

A woman's experience of unrelenting back pain with a fetus in an occipitoposterior position and the escalating interventions culminating in a cesarean birth is every midwife's nightmare. Intrathecal analgesia is a relatively simple and rapid method to provide maternal relaxation and relief from severe back labor. This article describes the use of intrathecal opioid analgesia in labor complicated by failure to progress in first-stage labor due to persistent occipitoposterior position of the fetus. Intrathecal analgesia has the advantage of being inexpensive and providing rapid onset of adequate pain relief for the first stage of labor. It does not cause motor blockade, so it allows the mother to be mobile and feel the urge to push. Consequently, there is no associated risk of an increased need for forceps or vacuum-assisted delivery. The authors note a decreased incidence of operative delivery for fetal occipitoposterior position with the use of intrathecal narcotics.

Adolescent↗
PubMed1992

Elevated maternal plasma corticotropin-releasing hormone levels in pregnancies complicated by preterm labor.

OBJECTIVES: We investigated whether maternal plasma levels of the placental hormone corticotropin-releasing hormone are elevated in pregnancies complicated by preterm labor. STUDY DESIGN: Mean maternal corticotropin-releasing hormone levels were studied in women who met specific criteria for preterm labor and in women with normal pregnancies. Levels were also compared in the latent and active phases during term labor. RESULTS: In pregnancies complicated by preterm labor, maternal corticotropin-releasing hormone levels were higher than in normal pregnancies; this elevation occurred before labor was diagnosed clinically (p less than 0.05). When preterm labor was associated with infection, the mean levels were not elevated. Mean plasma levels were similar in latent and active phases during labor at term. CONCLUSION: Maternal plasma corticotropin-releasing hormone levels are elevated in association with preterm labor. This elevation does not appear to be due to labor itself and may reflect an early activation of the placenta before the onset of preterm labor.

Corticotropin-Releasing Hormone↗
PubMed2001

Do very sick neonates born at term have antenatal risks? 1. Infants ventilated primarily for problems of adaptation to extra-uterine life.

AIMS: 1. Ascertain antenatal and intrapartum risk factors for term neonates ventilated primarily for 'perinatal asphyxia'. 2. Describe the neonatal morbidity and mortality. METHODS: Population-based case control cohort study. SETTING: Sydney and four large rural/urban health areas in New South Wales. SUBJECTS: Singleton term infants, no major congenital anomaly: subset of 83 infants ventilated primarily for 'asphyxia' from 182 cases admitted to a tertiary neonatal intensive care unit (NICU) for mechanical ventilation, 550 randomly selected controls. Outcome. Risk factors for case status by maternal, antenatal, labor, delivery, and combined epochs, adjusted odds ratios (OR), 95 per cent confidence intervals (CI), p < 0.05. RESULTS: Predictors of case status by multivariate epochs: Primigravida (1.8 [1.1, 2.8]), thyroid disease (7.8 [1.1, 57.0]), any antenatal complication (5.1 [3.0, 8.6]), growth restriction (4.2 [1.7, 10.4]), male gender (2.1 [1.3, 3.5]), gestational age >40 weeks (1.9 (1.1, 3.3)), prolonged rupture of membranes (9.7 [1.3, 72.5]), complicated labor (6.6 [3.7, 11.9]), induced labor (2.2 [1.3, 3.9]), prostaglandins 2.46 [1.23, 4.91]), maternal pyrexia (10.8 [2.8, 42.7]), placental hemorrhage in labor (OR 4.24 [1.45, 12.42]), forceps delivery (4.1 [1.9, 8.5]), emergency cesarean section (4.7 [2.6, 8.7]). Twenty case infants (24%) and no control infants died. CONCLUSIONS: This study has shown maternal and antepartum risk factors for severe neonatal morbidity in term infants. More centers need to become interested in the term baby, so that a larger multicenter study can further elucidate the heterogeneous causal pathways to term neonatal morbidity.

Adaptation, Biological↗
PubMed1995

Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery.

OBJECTIVE: To determine whether the addition of chiropractic care including craniosacral therapy to a regimen of standard obstetric pregnancy results in fewer obstetric interventions during labor and delivery. DESIGN: Retrospective, case-matched, static-group comparison. SETTING: The study group was obtained from a college faculty-based clinic and received chiropractic care in addition to their routine obstetrical care. The setting for the comparison group was unkown, but the care rendered was presumed to be primary medical obstetric care only. PATIENTS: A consecutive sample of 63 pregnant women who sought chiropractic care within the period under study. The reason for seeking care was not necessarily related to the pregnancy. The sample was primarily between 18 and 35 yr, non-Hispanic caucasian and primiparous. After selection and matching criteria, 35 patients remained in the study group. INTERVENTION: Chiropractic care and craniosacral therapy delivered during pregnancy vs. unknown care within the same county. MAIN OUTCOME MEASURES: Obstetric interventions during labor and delivery as reported by the birth attendant on the certificate of live birth. RESULTS: No statistical differences were detected in the rates of obstetric interventions used during labor or delivery between the two samples. Approximate large-sample 95% confidence intervals are provided. CONCLUSION: Because of the limitations in the design of the project, this study provides no evidence that the addition of chiropractic care and craniosacral therapy during pregnancy results in any observable benefit or detriment with regard to obstetric interventions used during labor and delivery and that chiropractic care for pregnancy-related neuromusculoskeletal disorders should not complicate labor or delivery.

Adolescent↗
PubMed1997

Herpes simplex virus seropositivity and reactivation at delivery among pregnant women infected with human immunodeficiency virus-1.

OBJECTIVE: Our purpose was to determine whether pregnant women infected with human immunodeficiency virus-1 have an increased risk of herpes simplex virus-2 seropositivity and herpes simplex virus reactivation at delivery. STUDY DESIGN: Sixty women infected with human immunodeficiency virus and 8408 other patients who were delivered at the University of Washington between 1989 and 1995 had herpes simplex virus serologic determinations at delivery. Genital herpes simplex virus cultures were obtained for 48 (80%) of the human immunodeficiency virus-infected women and 5567 (66%) of the controls. Logistic regression was used to adjust for possible confounding factors. RESULTS: Forty-five (75%) of human immunodeficiency virus-infected women and 2709 (32%) controls were seropositive for herpes simplex virus-2 (p < 0.0001). Eight percent of human immunodeficiency virus-infected women and 2% of controls had herpes simplex virus reactivation in labor (p < 0.05). CONCLUSIONS: Infection with herpes simplex virus-2 is common among pregnant women infected with human immunodeficiency virus. Herpes simplex virus reactivation complicates labor in this group more often than in other obstetric patients. The role of herpes simplex virus in perinatal human immunodeficiency virus transmission warrants further study.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Bacterial isolates from patients with preterm labor with and without preterm rupture of the fetal membranes.

OBJECTIVE: The aim of this study is to describe the bacterial flora of women in preterm labor with or without premature rupture of membranes. METHODS: Retrospective studies of 239 patients with preterm labor were performed. RESULTS: One hundred and twenty-three of 239 patients with preterm labor (51.5%) had bacterial vaginosis. Seventy of the 239 patients with preterm labor (29.3%) developed premature rupture of the membranes (preterm PROM). Of the 70 patients with preterm PROM, 51 (72.9%) had bacterial vaginosis. Therefore, 51 of the 123 patients with bacterial vaginosis (41.5%) developed preterm PROM. An increased number of organisms detected from the vaginal discharge in patients with preterm labor was associated with preterm PROM by Cochran-Armitage test. An increased number of organisms detected from the vaginal discharge in patients with preterm labor complicated with bacterial vaginosis was significantly associated with preterm PROM by Cochran-Armitage test. CONCLUSIONS: In preterm labor, the number of different species detected in the vagina provide sensitive and specific prediction of preterm PROM in patients with preterm labor.

Bacteria, Aerobic↗
PubMed2001

Outcomes of quintuplet pregnancies.

OBJECTIVE: To review the obstetric and perinatal complications associated with quintuplet pregnancies in the United States. STUDY DESIGN: The databases of two large support groups for higher order multiple gestations, the Triplet Connection and Mothers of Super Twins, were accessed for quintuplet pregnancies. Each record contained information regarding maternal demographics, obstetric complications and perinatal outcomes. The data were analyzed by the Student t test and chi 2 test as indicated, with a P value < .05 for significance. RESULTS: Complete data were obtained for 36 quintuplet pregnancies. Preterm labor complicated all pregnancies. Six pregnancies delivered prior to 24 weeks' gestation, with no surviving infants. In the remaining 30 pregnancies, the mean gestational age at delivery was 28.9 weeks (SD +/- 2.0). There were trends toward later gestational ages at delivery in pregnancies with prophylactic cerclage placement and among multiparous women; however, these trends were not statistically significant. The perinatal mortality rate for the entire sample was 253/1,000. When adjusted for pregnancies delivered beyond 24 weeks' gestation, the perinatal mortality rate was 83/1,000. Minor and major neonatal morbidity affected 20% (26/132) and 10% (13/132) of quintuplet neonates, respectively. CONCLUSION: Quintuplet pregnancies are associated with high rates of obstetric complications and significant perinatal morbidity and mortality.

Adult↗
PubMed1989

[Tissue pO2 and fetal heart activity during induction of labor with oxytocin].

A total of 65 women in labor complicated with uterine inertia were investigated for tissue pO2 and cardiac performance of fetuses under the effect of oxytocin. The authors stated that the aggravation of fetal status in drug-induced labors resulted from poorer tissue oxygenation caused by the activation of uterine contractility. In this line, hypoxic changes of the fetus were more pronounced in pregnancies complicated by nephropathy or prolonged pregnancy. Accurate monitoring of the fetal status and the character of induced labor course was found to be mandatory. Before oxytocin induction the fetus should be protected with diazepam.

Adult↗
PubMed1995

Amniotic fluid interleukin-10 concentrations increase through pregnancy and are elevated in patients with preterm labor associated with intrauterine infection.

OBJECTIVE: To better understand the role of the antiinflammatory cytokine interleukin-10 in preterm labor and infection, we evaluated the amniotic fluid interleukin-10 concentrations through pregnancy, in term, and in preterm labor. STUDY DESIGN: Amniotic fluid interleukin-10 levels were measured in 147 women throughout pregnancy including patients in the second trimester, patients at term with and without labor, and in patients in preterm labor with and without an intrauterine infection. We compared the amniotic fluid interleukin-10 concentrations among these five groups using the Mann-Whitney U test. RESULTS: Amniotic fluid interleukin-10 was detected in 70% to 91% of patients in each of the five study groups. Higher concentrations were found at term compared with the second trimester (p < 0.001) and concentrations were significantly greater in patients with preterm labor and intrauterine infection compared with those patients in preterm labor without infection (p < 0.001), patients at term in labor (p < 0.001), or patients at term not in labor (p < 0.001). When the patients in preterm labor with infection were analyzed by gestational age, those patients at < 30 weeks had significantly higher amniotic fluid concentrations of interleukin-10 (p = 0.014). CONCLUSIONS: Interleukin-10 was present in the amniotic fluid of the majority of pregnancies, with higher concentrations found at term compared with the second trimester. Intrauterine infection was associated with significantly increased concentrations, with even higher concentrations found in the very premature pregnancies. Interleukin-10 has a prominent yet undefined role in pregnancy and preterm labor complicated by intrauterine infection.

Amniotic Fluid↗
PubMed1982

Pregnancy outcome in 98 women exposed to diethylstilbestrol in utero, their mothers, and unexposed siblings.

The reproductive capability and labor complications of 98 women exposed to diethylstilbestrol (DES) in utero were compared with those of 3 separate control groups. The controls consisted of 167 age-matched, normal women, 20 siblings not exposed to DES who had achieved pregnancy, and their mothers. Spontaneous abortion, ectopic pregnancy, incompetent cervix, and premature labor occurred significantly more often in the DES-exposed population than in the normal controls. The controls also achieved a higher percentage of desired pregnancies overall; this was statistically significant (89.6 versus 75.0%, P less than .001). When compared with their mothers, however, the DES-exposed population achieved a greater percentage of desired, viable pregnancies (75.6 versus 67.0%, P less than .001). The unexposed siblings of the DES women achieved a higher percentage of desired, viable pregnancies than did their exposed sisters (86.9 versus 73.6%, P = .274), but less than the normal population (86.9 versus 89.6%).

Abortion, Incomplete↗
PubMedDate not supplied

Maternal health practices and complications of term labor.

The purpose of this study was to examine the relationships between a healthful life-style, demonstrated by selected health practices, and complications in term labor. A sample of 493 clinic patients were interviewed at term, but prior to the onset of labor, regarding nine health practices. In a logistic regression, three of the nine practices examined were associated with significant changes in the rate of intrapartum complications: smokers experienced fewer intrapartum problems, whereas those with excess weight for height at conception and those whose gestational weight gain exceeded 40 pounds experienced an increased incidence of complications.

Adolescent↗