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At least 667 records · Page 37Linked to original sources
PubMed1985

[Manual obstetrical examination method. Current status in West Germany].

Until the middle of the eighteenth century the manual method of obstetrical examination involved exterior examination in addition to vaginal exploration. During the post-Semmelweis era, that is particularly following the introduction of the rubber glove, vaginal examination was omitted in favour of combined rectal and exterior examination. Since about the 1970 the vaginal form of examination is again preferred, although this procedure is described with some controversy in most present-day textbooks on obstetrics and midwifery. Representative sample examination tests performed by 625 obstetricians and 1478 various clinics showed clearly that for the purpose of controlling uncomplicated pregnancies and births, most physicians employ the vaginal form of examination. Moreover, even in those cases involving pathological pregnancies and risk the vaginal examination is preferred, possibly all too unreservedly so.

Adult↗
PubMedDate not supplied

[Ultrasound Doppler sonography in obstetrics. A comparison between simple Doppler methods (continuous or pulsed Doppler) and the duplex system (combination of B-image and pulse Doppler)].

120 pregnant women between the 26th and 42nd week of gestation have been examined using simple Doppler-units with pulsed- or continuous-wave technique and duplex Doppler-units (combined B-mode and pulsed-wave Doppler). The umbilical and uterine arteries were measured with both units in a semi-recumbent position at the same time by the same examiner. Only ideal flow profiles were taken to calculate the S/D-ratio. Our results were correlated to the fetal outcome, to all cases of pre-eclampsia and to all cases of intra-uterine growth retardation. Except in one of these cases we got the majority of pathological results using simple Doppler-units. Only in pre-eclampsia the duplex Doppler-units had the majority of pathological results. Even in normal fetal outcome the majority of simple Doppler-unit results are pathological. This finding is due to the impossibility to localize the vessel exactly using simple Doppler-units. Sensitivity is higher in simple Doppler-techniques (74.3% to 52.9%), specificity is higher in duplex Doppler-technique (77.9% to 52.6%).

Female↗
PubMed1991

[Obstetric care and perinatal mortality in a rural area of northeastern Brazil].

This paper examines deliveries in a rural community of northeastern Brazil served by midwives who had received training that included the referral of pregnancies with complications; such training is essential to improve obstetrical care in rural areas of less developed countries. Data were collected on 1,661 women, of whom 62% gave birth in their homes and 38% in hospitals. The women referred to hospital were more likely to be primigravidas, to experience complications during labor, or to have had a stillbirth in the past. The parturients who were sent straight to hospital were more likely to have completed primary schooling or to have obtained prenatal care. The infant mortality rate was 32/1,000 births and the early neonatal mortality rate 14/1,000. For referred pregnancies these mortalities rose to 128 and 24, respectively. The factors significantly associated with perinatal mortality were advanced maternal age, the presence of prenatal pathology, abnormal presentation, complications in labor, and previous stillbirth. The low rate of perinatal mortality for young women and nulliparas and the disproportionally high number of nulliparas with deliveries in hospitals suggest that the midwives and health professionals providing prenatal care are aware of the problems associated with the first delivery and hence are providing prompt and appropriate care to these parturients. Family planning is recommended, especially for grand multiparas and older mothers. The early detection of abnormal presentation and the transfer of these women to surgical facilities should improve perinatal prognosis.

Adolescent↗
PubMedDate not supplied

The fetus with gastroschisis managed by a trial of labor: antepartum and intrapartum complications.

OBJECTIVE: To assess the rate of antepartum and intrapartum complications of fetuses with antenatally diagnosed gastroschisis managed in a center that advocates a trial of labor. STUDY DESIGN: A retrospective review. The medical records of 49 fetuses (1988 to 1997) who were prenatally diagnosed with gastroschisis by a sonologist in the Ultrasound Genetic Unit, Department of Obstetrics and Gynecology at Washington University, were reviewed. RESULTS: Oligohydramnios and intrauterine growth restriction were diagnosed in 23% and 49% of the pregnancies, respectively. A total of 22 women underwent induction of labor nine for nonreassuring fetal testing, four for premature rupture of membranes, five for marked bowel dilatation, one for preeclampsia, and three for other reasons. Cesarean section (CS) was performed in 16 of 43 (37%) of women. The indications for CS were fetal distress (9 of 16 women), chorioamnionitis (2 of 16 women), breech presentation (3 of 16 women), and physician discretion (2 of 16 women). No significant differences in Apgar scores were observed between the fetuses. Fetuses who were delivered by CS for fetal distress were more likely to have undergone an induction of labor (91% versus 44%), and they were smaller than fetuses with no evidence of fetal distress (2220 +/- 105 gm versus 2613 +/- 80 gm, p < 0.05). CONCLUSION: The incidence of antepartum and intrapartum complications in fetuses with gastroschisis is high. The rate of CS can reach 37%. These data may aid clinicians in counseling patients with gastroschisis.

Adult↗
PubMed2006

Drug therapy during labor and delivery, part 2.

PURPOSE: The drug therapy of common conditions and complications during labor and delivery and the fetal and neonatal effects of this therapy are examined. SUMMARY: The pharmacologic therapy of common conditions that occur in labor and delivery primarily involves oxytocin and prostaglandins for cervical ripening and labor induction and systemic and regional narcotic analgesics for pain. Because most medications used in women during labor and delivery do not have Food and Drug Administration-approved labeling, pharmacists should understand the benefits and limitations of medications used in the mother. Although induction and augmentation of labor and the control of pain often require drug therapy, other, less frequent, complications may occur in labor. Drug therapies for these complications include anti-infective agents to treat maternal infection and prevent neonatal diseases; antiretrovirals to reduce perinatal HIV-1 transmission from the mother to the fetus; corticosteroids to prevent fetal lung immaturity; antihypertensives to treat preeclampsia; anticonvulsants to treat eclampsia; antibiotics to prolong pregnancy and improve neonatal outcomes after premature rupture of the membranes; tocolytics for premature labor; and oxytocin, ergot alkaloids, and prostaglandin analogues for postpartum hemorrhage. The fetal and neonatal effects of therapy for the conditions that occur during labor and delivery are usually benign, but significant morbidity and mortality involving the mother, the fetus, and the newborn are ever-present risks. CONCLUSION: Awareness of the conditions and complications requiring drug therapy during labor and delivery will allow hospital pharmacists to make knowledgeable decisions about the rapid accessibility of critical medications in the labor and delivery unit.

Analgesia, Obstetrical↗
PubMed1999

Amnioinfusion in term labor with low amniotic fluid due to rupture of membranes: a new indication.

OBJECTIVE: The null hypothesis was that the use of intrapartum amnioinfusion to induce term labor because of premature rupture of membranes when labor was complicated by low amniotic fluid volume due to vaginal loss would not improve fetal heart rate patterns, decrease the incidence of operative delivery, or improve neonatal acid-base status. STUDY DESIGN: 200 term pregnancies with low amniotic fluid due to vaginal loss were randomly chosen to receive intrapartum amnioinfusion or standard obstetric care without amnioinfusion. Fetal heart rate pattern, method of delivery and neonatal acid-base status were compared with Student's t test, chi-squared analysis, Mann-Whitney U- or Fisher's exact test. RESULTS: When amnioinfusion was used, the fetuses had lower rates of variable (74 vs. 91%, P<0.01) or late (26 vs. 58%, P<0.001) decelerations. Spontaneous deliveries were more frequent (77 vs. 59%, P<0.01) and cesarean sections less frequent (3 vs. 10%, P<0.05). Mean umbilical arterial (7.24+/-0.07 vs. 7.21+/-0.08, P<0.01) and venous (7.31+/-0.06 vs. 7.28+/-0.08, P<0.01) pH were significantly higher in newborns with amnioinfusion, and babies in this group had lower rates of neonatal acidemia of arterial (22 vs. 36%, P<0.005) or venous (13 vs. 26%, P<0.005) origin. CONCLUSIONS: Amnioinfusion improved fetal heart rate pattern, lowered the incidence of operative delivery, and improved neonatal acid-base status in term labor complicated by low amniotic fluid due to vaginal loss.

Adult↗
PubMed1988

[Serum lipid and lipoprotein concentrations in pregnancy and at onset of labor in normal and complicated pregnancies caused by hypertensive gestosis and fetal growth retardation].

Cholesterol triglyceride and lipoprotein concentrations were determined in the sera of 220 pregnant women at different periods of their pregnancy. In 197 healthy pregnant women we found besides an increase in cholesterol level and in particular an increase in the beta-lipoprotein fractions, a marked increase in pre-beta-lipoprotein levels and more than twice as high triglyceride concentration in the course of the first to the third trimenon. Nothing abnormal was found on comparing the lipid and lipoprotein parameters of 13 pregnant women having hypertensive toxaemia, with those of healthy gravidae, with the exception of a marked increase in the pre-beta-lipoprotein levels in those patients who suffered from toxaemia. No connection was seen between infantile deficient development below the tenth percentile and the serum lipid and lipoprotein concentrations (n = 10) in the mother. Examinations carried out in 233 pregnant women and their children at the time of birth did not yield any connections between maternal and infantile protein patterns. All infants had definitely lower parameter concentrations than their mothers.

Adolescent↗
PubMed2006

[Labor management using epidural anesthesia in a gravida patient with high spinal injury].

Since autonomic hyperreflexia (AH) is a serious complication during labor in a gravida with spinal cord injury, anesthetic measures should be taken for the suppression of AH even in a sensory-loss condition. Several reports have described various methods for the suppression of AH, in which epidural anesthesia has been advocated as a useful means for the prevention or amelioration of AH. However, it is difficult to evaluate the efficacy of epidural anesthesia due to the lack of sensory and motor functions. We report a primipara who had spinal cord injury below the T 3 level at the age of 17 due to a traffic accident and underwent successful vaginal delivery twice under epidural anesthesia at the ages of 30 and 32. For the first delivery, we placed two epidural catheters. We controlled the rate and the content of epidural infusion through the two different injection sites so as to meet delivery process. For the second delivery we did epidural anesthesia in the same way. Tubal-ligation was also performed under epidural anesthesia after the second delivery. No major obstetric complication including AH occurred in either of delivery. The woman with high spinal injury could have two healthy children without major complications during labor by the cooperation of gynecologists and anesthesiologists.

Adult↗
PubMed2006

Drug therapy during labor and delivery, part 1.

PURPOSE: The drug therapy of common conditions and complications during labor and delivery and the fetal and neonatal effects of this therapy are examined. SUMMARY: The pharmacologic therapy of common conditions that occur in labor and delivery primarily involves oxytocin and prostaglandins for cervical ripening and labor induction and systemic and regional narcotic analgesics for pain. Because most medications used in women during labor and delivery do not have Food and Drug Administration-approved labeling, pharmacists should understand the benefits and limitations of medications used in the mother. Although induction and augmentation of labor and the control of pain often require drug therapy, other, less frequent, complications may occur in labor. Drug therapies for these complications include anti-infective agents to treat maternal infection and prevent neonatal diseases; antiretrovirals to reduce perinatal HIV-1 transmission from the mother to the fetus; corticosteroids to prevent fetal lung immaturity; antihypertensives to treat preeclampsia; anticonvulsants to treat eclampsia; antibiotics to prolong pregnancy and improve neonatal outcomes after premature rupture of the membranes; tocolytics for premature labor; and oxytocin, ergot alkaloids, and prostaglandin analogues for postpartum hemorrhage. The fetal and neonatal effects of therapy for the conditions that occur during labor and delivery are usually benign, but significant morbidity and mortality involving the mother, the fetus, and the newborn are ever-present risks. CONCLUSION: Awareness of the conditions and complications requiring drug therapy during labor and delivery will allow hospital pharmacists to make knowledgeable decisions about the rapid accessibility of critical medications in the labor and delivery unit.

Adrenal Cortex Hormones↗
PubMed1999

Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial.

CONTEXT: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. OBJECTIVE: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. DESIGN AND SETTING: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). SUBJECTS: Obstetricians and their preterm delivery cases at participating hospitals. INTERVENTION: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. MAIN OUTCOME MEASURE: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). RESULTS: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. CONCLUSION: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Anti-Inflammatory Agents↗