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At least 577 records · Page 32Linked to original sources
PubMed1996

Uterine rupture as a cause of shoulder dystocia.

BACKGROUND: Shoulder dystocia and uterine rupture are complications that rarely are related. CASE: A 34-year-old white woman, gravida 4, para 2, therapeutic abortion 1, was admitted for labor induction. Fetal heart rate monitoring was normal until full dilation, when bradycardia developed and persisted. With the use of forceps, the vertex was delivered. Head retraction signaled the possibility of shoulder dystocia. Attempts at vaginal delivery failed, necessitating abdominal delivery. The fetal body was found anterior to the already contracted, anterolaterally ruptured uterus. An abdominally assisted vaginal delivery was accomplished. CONCLUSION: Uterine rupture may be an unsuspected cause of shoulder dystocia.

Adult↗
PubMed1994

Intrapartum, atraumatic, non-asphyxial intracranial hemorrhage in a full-term infant.

BACKGROUND: Intracranial hemorrhage in a full-term infant is uncommon, is usually subarachnoid in type, and is usually associated with operative vaginal delivery or asphyxia. CASE: A 15-year-old primigravid woman at 37 weeks' gestation developed a prolonged second stage of labor associated with persistent occiput posterior position. With the onset of pushing, baseline fetal heart rate (FHR) decreased and variability increased. Thirty minutes before vaginal delivery, sudden fetal tachycardia (up to 210 beats per minute) was observed, with absent variability and minimal decelerations. At birth, the infant was apneic and hypotonic, but lacked biochemical evidence of acidemia or asphyxia; seizures developed in the early neonatal period. Subarachnoid hemorrhage was demonstrated by computed tomography of the head. CONCLUSION: The occiput posterior position, marked molding, and prolonged labor with compulsive pushing may be associated with an increased risk of adverse outcome, even unrelated to the details of delivery. The change in FHR pattern, to a lowered baseline rate and increased variability, suggests increased intracranial pressure. The sudden change to fetal tachycardia with absent variability before delivery suggests intracranial hemorrhage or injury.

Adolescent↗
PubMed1984

Clinical significance of fetal heart rate patterns during labor. VIII. Breech presentations.

The fetal heart rate (FHR) tracings of 302 consecutive breech presentations were analyzed to assess their potential value in clinical practice. There were 274 singleton births, 27 first twins and 1 triplet. Ten percent of the gestations were greater than or equal to 42 weeks, and 26% were less than or equal to 36 weeks. Infants premature by weight (less than 2,500 gm) made up 32%. Only 33.3% had no decelerations, and 63.0% had variable or variable-late decelerations. The latter group had a significantly higher incidence of depressed neonates and neonatal deaths. When accelerations were present, there were significantly fewer depressed infants and neonatal deaths. Overall the perinatal mortality (PNM) was 7.9%; for premature infants it was 27%, postterm 3% and term 1%. There was a 31% incidence of cesarean section. The PNM, when analyzed according to route of delivery, was no different for the very-low-birth-weight, low-birth-weight and term infants. Weight-specific mortality accounted for the apparent difference among the very-low-birth-weight infants. The high incidence and pathophysiology of cord compression (for first- and second-stage labor) may explain the higher incidence of depression in breeches as compared to cephalics. FHR monitoring should be done throughout delivery in order for the physicians to intervene on time when fetal distress is imminent.

Birth Weight↗
PubMed1985

Uterine rupture in Nigeria.

Uterine rupture in the developing world remains a significant problem. We treated 45 such cases. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), hand presentation (50%), prolonged labor (42%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy.

Adolescent↗