[Risk associated with variable deceleration developing at stage 1 of delivery].
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The vaginal examination data (dilation, station, and time) were examined from 2845 consecutive uncomplicated patients who were admitted in early labor to Cleveland Metropolitan General Hospital between January 1, 1979 and December 31, 1982, using data from the computer database of the Perinatal Clinical Research Center. The length of the latent phase of labor was calculated in 2479 of these patients to form the study group. Individual effects of parity and the cervical dilation on the length of the latent phase of labor resembled Friedman's results from 20 years ago. Furthermore, the average and prolonged lengths of the latent phase confirmed that labors have not changed appreciably in 20 years. However, multivariable analysis and standard stepwise regression on all of the vaginal examination data revealed that the largest influence on the length of latent labor was the admitting cervical dilation. Parity had only a small effect when cervical dilation was controlled. Thus, a multiparous patient may progress as slowly as a primiparous patient if they both are admitted with a low cervical dilation.
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A prospective study was conducted of 100 consecutive admissions to the neonatal intensive care unit of the Hospital for Sick Children, Toronto, of infants with respiratory distress syndrome or transient tachypnea of the newborn. It was found that in 15% of cases the illness was completely preventable, being the result of unintentionally premature termination of pregnancy. Significant intrapartum asphyxia occurred in 44% of the infants in whom respiratory distress syndrome developed. Factors placing the pregnancy at high risk were present antenatally in most cases, and most of the deliveries took place in hospitals without adequate facilities or staff, or both, for the requirements of the infant at and following birth.
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In 32 patients undergoing emergency intrapartum caesarean section labour was suppressed with 250 micrograms salbutamol. The biochemical status of the neonates was compared with that of 15 controls. The initial results did not demonstrate a major difference between the two groups, but when only proven cases of fetal distress (H less than 7,25) in the two groups were compared, a significant improvement in the PO, pH and base deficit values in the umbilical vein as well as in the PO2 and pH values in the umbilical artery was noted in the group which had been given salbutamol. No major maternal side-effects were noted and this, together with the simplicity of the regimen, makes it a valuable temporizing measure in such cases.
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The effectiveness of beta 2-adrenergic stimulants as suppressants of active labour is well known. This study examines the effects of salbutamol upon established labour in 32 patients undergoing emergency caesarean section. Twenty-five (78,1%) of the patients studied showed a sustained and effective suppression of labour after a bolus intravenous injection of 250 micrograms salbutamol. In 6 of the 7 remaining patients the parameters of uterine activity were also dramatically decreased, but because uterine activity recurred, it had to be further suppressed with an intravenous infusion. There was only 1 refractory case. No serious maternal or fetal side-effects were noted, and patient acceptance was good.
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