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PubMed1982

Singleton breech presentation in labor: experience in 1980.

Excessive perinatal loss is associated with breech presentation, and, in large measure, this loss is accounted for by prematurity, congenital anomalies, and birth trauma. In the endeavor to exert an effect on two of these problems, cesarean section has been resorted to increasingly. Three hundred thirty singleton breech pregnancies were reviewed, and delivery in 74.2% of these was by cesarean section. The only cases in which a trial of labor was routinely allowed were frank breech presentations at term. Fetal compromise during labor and delivery was relatively uncommon and seen to occur at both vaginal delivery and cesarean section. Preventable mortality was limited to infants who weighed less than 1,300 gm. Morbidity was also primarily associated with low birth weight, and was not significantly different in term infants delivered vaginally and those delivered by cesarean section. The conclusion drawn is that a liberal policy toward the use of cesarean section for breech presentation is necessary in conjunction with the manual skills required to effect a safe breech delivery, in order to minimize perinatal loss.

Breech Presentation↗
PubMed1980

Infants of mothers treated with ethanol for premature labor.

Presented is a retrospective study of the newborn infants of mothers who were treated with ethanol in order to arrest premature labor, in comparison with matched control infants. In regard to neonatal mortality, there was no statistical difference between the study and the control infants. However, infants born within 12 hours after administration of ethanol had a significantly lower 1-minute Apgar score and a higher incidence of respiratory distress syndrome. This indicates that treatment with ethanol should be discontinued as soon as it becomes evident that labor cannot be arrested.

Apgar Score↗
PubMed2002

Voluntary counseling and testing for HIV among pregnant women presenting in labor in Kigali, Rwanda.

This study investigated factors related to acceptability of voluntary counseling and testing (VCT) for HIV among pregnant women presenting in labor in Kigali, Rwanda, in an era of free and effective antiretroviral drugs for prevention of perinatal transmission of HIV. A pilot-tested questionnaire was administered to study participants to solicit information regarding their intentions to accept or refuse VCT and treatment of HIV infection during labor and delivery if confirmed infected. Two factors correlated significantly with the acceptance rate. The strongest predictive factor for acceptability of HIV testing was the profession of the male partner. Women whose partners had skilled and well-paid jobs were about four times more likely to accept HIV testing than were women whose partners were unemployed (adjusted odds ratio, 3.5; confidence interval, 1.16-10.85). The other factor significantly associated with the acceptance rate was maternal age. The likelihood of acceptance of HIV testing was about three times higher among women 35 years or older than among younger mothers (adjusted odds ratio, 3.1; confidence interval, 1.01-9.4). For every 5-year increment in maternal age, the odds of acceptance of HIV testing increased by a factor of 1.20. Using this important finding, we constructed an acceptance rate probability curve that could serve as a useful tool to evaluate the efficacy of future interventions aimed at improving the acceptability rate of HIV testing among pregnant women at the study site.

Adult↗
PubMed2002

Rising rates of labor induction: present concerns and future strategies.

The rate of labor induction nationwide increased gradually from 9.5% to 19.4% between 1990 and 1998. Reasons for this doubling of inductions relate to widespread availability of cervical ripening agents, pressure from patients, conveniences to physicians, and litigious constraints. The increase in medically indicated inductions was slower than the overall increase, suggesting that induction for marginal or elective reasons has risen more rapidly. Data to support or refute the benefits of marginal or elective inductions are limited. Many trials of inductions for marginal indications are either nonexistent or retrospective with small sample sizes, thereby limiting definitive conclusions. Until prospective clinical trials can better validate reasons for the liberal use of labor induction, it would seem prudent to maintain a cautious approach, especially among nulliparous women. Strategies are proposed for developing evidence-based guidelines to reduce the presumed increase in health care costs, risk of cesarean delivery for nulliparas, and overscheduling in labor and delivery.

Adult↗
PubMed1984

The unanticipated breech presentation in labor.

In summary, the obstetrician often cannot anticipate the appearance of a woman with a breech fetus in labor, and, in the majority of instances, a woman will be in labor before the diagnosis is made. To obtain the best outcome with both preterm and term breech fetuses, the appropriate data must be obtained rapidly, and a plan of management based on this data must be developed. Management protocols outlined in this article, although not ensuring a good outcome in every instance, most often will result in the delivery of a healthy newborn. We should emphasize again that if the information described above is not available, then the safest course in most instances is delivery by cesarean section.

Body Weight↗
PubMed2001

Induction of labor in breech presentation.

OBJECTIVE: Induction of labor in breech presentation, although not contraindicated, has rarely been reported. We have undertaken to evaluate the safety and outcome of this practice in two Israeli institutions along with a literature review of this controversial subject. METHOD: The research design was a retrospective case control study covering the years: 1980-1999. We have studied 53 term (>37 weeks) breech deliveries induced for various medical and obstetrical reasons, in two major regional hospitals in Israel. Induction was performed with prostaglandin E(2) for the unripe cervix and with oxytocin for induction or augmentation when the cervix was ripe. Six women were induced by nipple stimulation. Controls were 53 women with spontaneous labor in breech presentation that had a trial of vaginal delivery, and 54 women with breech presentation who delivered by elective cesarean section. RESULT: No significant difference in the various maternal and fetal outcomes was observed. CS rate was comparable in both study and control groups (34% vs. 32%) and two-thirds gave birth vaginally. CONCLUSIONS: In properly selected and carefully managed cases of breech presentation, induction of labor seems a safe and reasonable option.

Adult↗
PubMed1998

Molecular aspects of preterm labor.

Preterm birth is a major problem in clinical obstetrics, occurring in approximately 10% of all pregnancies, and leading to 75% of early neonatal mortality and morbidity. Studies in our laboratory have examined the neuroendocrine mechanisms by which the fetus, through activation of the hypothalamic-pituitary adrenal axis, provides the stimulus to the onset of parturition. Maturation of this axis occurs prematurely in response to stimuli such as stress. Stress induced activation of HPA function in human pregnancy, may lead to increased output of corticotropin-releasing hormone (CRH) from placenta and fetal membranes. CRH is one of the agonists that acts in concert with increased prostaglandin biosynthesis to provide the stimulus to myometrial contractility in late gestation. Recent studies have also recognized that approximately 15% of patients in idiopathic preterm labor present, with deficiency of the major prostaglandin metabolizing enzyme in the fetal membranes, particularly chorionic trophoblast. Understanding these processes may lead to new methods of managing the patient presenting in preterm labor.

Corticotropin-Releasing Hormone↗