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PubMed1980

[On the reliability of case history data on parturition (author's transl)].

Case history data on the course of parturition (recorded during the sixth week of life and the twelfth month of life) are compared with each other, as well as with the actual course of parturition, within the framework of a prospective study covering the first year of life. The information regarding auxiliary obstetrical measures, position anomalies, as well as deviations from the normal weight at birth, were associated with a probability of error of less than five per cent. All other data regarding umbilical cord complications, asphyxia, etc. were associated with various error probabilities up to 20 per cent. It is concluded from these results that data on the history of parturition merely have the character of good estimates on account of their poor validity and reliability. This must be taken into account both in the statistical processing of medical data and in the employment of case history data for the pathogenetic interpretation of an actual disease picture, especially minimal cerebral dysfunction in children (MCD).

Asphyxia Neonatorum↗
PubMed1984

[The course of labor following cesarean section with special reference to peridural anesthesia].

In a retrospective study the mode of delivery by 565 pregnant women who had previously undergone Caesarean section, was explored on the basis of their medical records. Particular attention was paid to the problem of PDA. Primary Caesarean section was performed in about 25% of the cases and secondary Caesarean section 22%. 57% of the women who had previously delivered via Caesarean section, now delivered vaginally. 71,4% of these patients had peridural anaesthesia during labour. In 17 cases laparotomy following vaginal delivery was necessary because of suspected rupture of the uterus due to rupture of the uterine scar. In 10 cases this diagnosis was confirmed. The authors come to the conclusion that previous Caesarean section is no indication for a repeat Caesarean section. Under exactly controlled conditions the authors were able to clarify that PDA can be safely applied in patients with previous Caesarean section.

Anesthesia, Epidural↗
PubMed1984

[Cerclage and tocolysis in twin pregnancies].

From 1977 to 1981, 29 twin pregnancies were managed by cerclage and tocolysis and this group was compared to 28 twin pregnancies without cerclage. The average birth weight in both groups did not differ significantly. In the group with cerclage 91% of the infants had a birth weight of 2000 or over 2000 gm and none was born prior to 34 weeks gestation. In the group without cerclage, five infants were born prior to 34 weeks gestation and only 76% had a birth weight of 2000 gm or higher. The perinatal mortality in the group with cerclage was zero percent; in the group without cerclage, one died at 31 weeks gestation. The avoidance of deliveries of very small and immature infants inascribed to the influence of cerclage and tocolysis. In the group with cerclage there was a higher incidence of small gestational age infants and a higher incidence of rupture of the membranes and operative deliveries. These were due to a random increase of malpositions. Our results are limited by the fact that the cerclage was done in all cases prior to 27 weeks gestation whereas the group without cerclage did not have the diagnosis of twin pregnancies established prior to 27 weeks gestation in 75% of the cases.

Birth Weight↗
PubMed1978

Effect of fetal monitoring on neonatal death rates.

We analyzed data from 15,846 live-born infants to assess the effect of electronic fetal monitoring on neonatal death rates. The crude neonatal death rate was 1.7 times higher in unmonitored infants than in those monitored. Adjusting for inherent risk and changes in mortality rates and monitoring rates during the years of the study lowered the relative risk to 1.4 (95 per cent confidence interval, 0.85 to 2.45). The estimated yield from monitoring decreased as the inherent risk of the baby declined. Thus, in the highest-risk group 109 lives might be saved for every thousand babies monitored. In the lowest risk group (babies at term with no risk factors) the neonatal death rate is around one per thousand. The absolute benefit for this large group could therefore not exceed one life saved for every thousand babies monitored.

Female↗
PubMed2003

Uterine contractility in women whose fetus is delivered in the occipitoposterior position.

OBJECTIVE: Most fetuses in the occipitoposterior position rotate spontaneously after striking the pelvic floor. The increased prevalence of prolonged labor, operative delivery, and oxytocin augmentation in women with an occipitoposterior fetal position seems consistent with decreased uterine contractility. We sought to test the hypothesis that women with a persistent occipitoposterior fetal position have inadequate intrauterine pressure. STUDY DESIGN: Intrauterine pressure was measured prospectively electronically in 94 women whose labor pain was controlled by patient-requested epidural analgesia. Eleven women (12%) were delivered as a persistent occipitoposterior fetal position. In a nested case-control study, these women were compared with 22 women who were delivered as an occipitoanterior fetal position who were matched for age, parity, gestational age, cervical examination at study enrollment, and body mass index. The intrauterine pressure measurements were initiated during the first stage of labor and continued throughout the entire labor process. Women were encouraged in the second stage of labor, after a period of recording baseline contractility, to push using a standardized Valsalva maneuver once the vertex reached the +2 station. The area under the intrauterine pressure curve (integral) was used to estimate uterine contractility and expulsive performances. RESULTS: Five women (45%) in the occipitoposterior group required operative delivery. The average duration of the second stage of labor in the occipitoposterior group was 91.4 +/- 23.2 minutes compared with 51.7 +/- 6.6 minutes in the occipitoanterior fetal position (P =.04). Ninety percent of women in the occipitoposterior group required oxytocin, compared with 59% of the women in the occipitoanterior group (P =.11). There were no differences in uterine contractility between occipitoposterior and occipitoanterior groups during either the first stage of labor (integral mean +/- SEM: occipitoposterior [1685.3 +/- 194.6 mm Hg. s] vs occipitoanterior fetal position [1700.8 +/- 128.9 mm Hg. s, P =.98]) or second stages of labor (occipitoposterior [1952.6 +/- 186.5 mm Hg. s] vs occipitoanterior fetal position [1740.8 +/- 104.3 mm Hg. s, P =.46]). Further, there were no significant differences in pushing performances between the occipitoposterior and occipitoanterior groups (Valsalva maneuver: occipitoposterior 2864.9 +/- 328.8 mm Hg. s] vs occipitoanterior [2898.6 +/- 222.2 mm Hg. s, P =.90]). CONCLUSION: Women who were delivered as a persistent occipitoposterior fetal position do not have lower intrauterine pressure levels immediately before or during the second stage of labor.

Adult↗
PubMed2003

Uterine rupture: risk factors and pregnancy outcome.

OBJECTIVES: This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN: We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS: Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively). CONCLUSION: Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.

Adult↗
PubMed2006

Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001.

OBJECTIVE: To identify maternal and fetal risk factors associated with persistent occiput posterior position at delivery, and to examine the association of occiput posterior position with subsequent obstetric outcomes. METHODS: This is a retrospective cohort study of 30 839 term, cephalic, singleton births. Women with persistent occiput posterior (OP) position at delivery were compared to those with occiput anterior (OA) position. Demographics, obstetric history, and labor management were evaluated and subsequent obstetric outcomes examined. Potential confounding variables were controlled for using multivariate logistic regression analysis. RESULTS: The overall frequency of OP position was 8.3% in the study population. When compared to Caucasians, a higher rate of OP was observed among African-Americans (OR = 1.4, 95% CI 1.25-1.64) while no other racial/ethnic differences were noted. Other associated factors included nulliparity, maternal age > or =35, gestational age > or =41 weeks, and birth weight >4000 g, as well as artificial rupture of the membranes (AROM) and epidural anesthesia (p < 0.001 for all). Persistent OP was associated with increased rates of operative vaginal (OR = 4.14, 95% CI 3.57-4.81) and cesarean deliveries (OR = 13.45, 95% CI 11.94-15.15) and other peripartum complications including third or fourth degree perineal lacerations (OR = 2.38, 95% CI 2.03-2.79), and chorioamnionitis (OR = 2.10, 95% CI 1.81-2.44). CONCLUSION: Epidural use, AROM, African-American ethnicity, nulliparity, and birth weight >4000 g are associated with persistent OP position at delivery, with higher rates of operative deliveries and obstetric complications. This information can be useful in counseling patients regarding risks and associated outcomes of persistent OP position.

Adult↗
PubMed2001

Determination of fetal occiput position by ultrasound during the second stage of labor.

OBJECTIVE: To investigate whether ultrasonography is superior to vaginal examination for determination of fetal occiput position during the second stage of labor. METHODS: We conducted a prospective cohort study of 44 parturients. During the second stage of labor, an attending obstetrician performed a vaginal examination to detect fetal occiput position. This was followed by combined abdominal and perineal ultrasound examination. The two methods were compared to the true position. Results were analyzed using Student's t test for quantitative parameters. McNemar's and Fisher's exact tests were applied in order to examine differences between the study groups. RESULTS: The error rate in detecting fetal occiput position was significantly lower using the ultrasound technique (6.8%) compared to vaginal examination (29.6%, p = 0.011). Parity, maternal body mass index or fetal weight had no influence on the error rate. CONCLUSIONS: Ultrasonographic determination of the fetal position is an accurate technique and is superior to vaginal examination.

Cohort Studies↗
PubMed2002

Intrapartum sonography to determine fetal head position.

OBJECTIVE: To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head. PATIENTS AND METHODS: In 496 singleton pregnancies in labor at term, the fetal head position was determined by routine transvaginal digital examination by the attending midwife or obstetrician. Immediately before or after the clinical examination, the fetal head position was determined using transabdominal ultrasound by an appropriately trained sonographer who was not aware of the clinical findings. The digital examination was considered to be correct if the fetal head position was within 45 degrees of the ultrasound finding. The accuracy of the digital examination was examined in relation to maternal characteristics and the progress of labor. RESULTS: The position of the fetal head was determined by ultrasound examination in all 496 cases examined. Digital examination failed to define the fetal head position in 166 (33.5%) cases and, in 330 cases where the position was determined, the findings of the digital and sonographic examinations were in agreement in only 163 (49.4%) cases. The rate of correct identification of the fetal position by digital examination increased with cervical dilatation, from 20.5% at 3-4 cm to 44.2% at 8-10 cm, and was higher if the examination was carried out by an obstetrician than a midwife (50% versus 30%) and if there was absence rather than presence of caput (33% versus 25%). CONCLUSIONS: Routine digital examination during labor fails to identify the correct fetal position in the majority of cases.

Adolescent↗
PubMed2001

Failure to progress in the second stage of labour.

Spontaneous vaginal delivery without obstetric intervention remains the goal for most pregnant women. Midwives and obstetricians aim to support women in achieving this result, which is associated with the lowest risk of morbidity for both mother and baby. Despite the best efforts of the labouring woman and her carers, some women will fail to progress in the second stage of labour, and obstetric intervention will be required. This review evaluates recent data addressing the diagnosis, aetiology and management of failure to progress in the second stage of labour, and explores aspects of maternal and neonatal morbidity associated with this event.

Analgesia, Epidural↗