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PubMed1992

Increased risk of postnatal depression after emergency caesarean section.

OBJECTIVE: To examine whether women having an emergency caesarean section are at increased risk of developing postnatal depression at one, three and six months postpartum. DESIGN: Participants were part of a larger study examining the relationship between personality dysfunction and postnatal depression. All women were recruited at an antenatal clinic in the first trimester of their pregnancy. These women were followed up at one, three and six months postpartum to identify cases of postnatal depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Data were collected from 188 women, who were divided into three groups by method of delivery: 21 women had an emergency caesarean section, 49 had a forceps delivery and 118 had a spontaneous vaginal delivery. Comparison of the groups indicated a significant difference at three months postpartum only. Women having an emergency caesarean section had significantly higher EPDS scores than women who had forceps or spontaneous vaginal delivery (9.15 +/- 6.18 v. 5.05 +/- 3.81 v. 5.79 +/- 4.47; F(2,143) = 4.2, P less than 0.02). Analysis of postnatal depression at three months indicated that women in the emergency caesarean section group had a relative risk of 6.82 (95% confidence interval, 2.85-16.15) compared with women in the other groups. CONCLUSIONS: When compared with women having spontaneous vaginal or forceps deliveries, women having an emergency caesarean section had more than six times the risk of developing postnatal depression three months postpartum. Special attention to this group appears warranted.

Cesarean Section↗
PubMed1992

The diagnosis and management of dystocia of the shoulder.

Dystocia of the shoulder is an unpredictable obstetric emergency that may result in injury to the mother or fetus. In an effort to reduce such risks, attempts have been made to identify patients having a fetus who may subsequently develop shoulder dystocia. The literature, however, clearly reflects that even the combination of prenatal historic facts, estimated fetal weight and sequence of intrapartum events is ineffective in prospectively identifying infants whose births are complicated by shoulder dystocia. During a ten year period at the University of Mississippi Medical Center, the incidence of macrosomia, shoulder dystocia and subsequent brachial plexus injury was reviewed. The majority of instances (89 percent) of shoulder dystocia occurred in patients weighing less than 8 pounds 13 ounces at birth. In the current retrospective review, only 11 percent of the women had risk factors for macrosomia or shoulder dystocia and among these, none were identified prospectively. Additionally, 91 percent of patients with brachial plexus injury recovered with no sequelae. One instance of brachial plexus injury occurred at the time of cesarean section. These data reveal that macrosomia and subsequent shoulder dystocia cannot be predicted. Therefore, it is not feasible to prevent brachial plexus injury prospectively by prophylactic cesarean section. Great clinical acumen and technical expertise by the obstetrician using a variety of methods may be useful in avoiding, as much as possible, injury to the mother and fetus when shoulder dystocia does occur.

Birth Weight↗
PubMed2003

The caesarean section rate in the Republic of Ireland in 1998.

The Caesarean section (CS) rate has risen dramatically in the United Kingdom and North America over the past 20 years. There are no recent data in the Republic of Ireland on CS rates. Our aim was to ascertain the national CS rate for the year 1998. In addition, we sought to determine instrumental delivery rates and epidural rates. Twenty-two of 24 units replied to a questionnaire giving a response rate of 92%. The CS rate was 17.8% (12.8-26.7%), 7.5% were elective and 10.3% were emergency. The size or type of the maternity unit did not influence the CS rate. The cause for the rise in the CS rate is multifactorial. Review of the current literature would suggest that a further rise in the CS rate in Ireland is likely.

Analgesia, Epidural↗
PubMed1986

Delivery of the very low birthweight baby.

The outlook for the baby weighing less than 1500 g at birth has dramatically improved over the last decade largely due to advances in neonatal intensive care. This, however, has created new clinical dilemmas in obstetric management and delivery. This article provides a critical review of published work, highlights the questions that remain unanswered and suggests guidelines for clinical management in the light of current knowledge.

Anesthesia, Obstetrical↗
PubMed1986

[Effect of lumbar peridural analgesia on the evolution of the number of delivery-associated operations].

The authors analyse the obstetric material of ten years of their institute in terms of the rate of delivery-completing operations. Lumbar peridural analgesia was introduced in the fourth year of the period under scrutiny. In the course of ten years we delivered 16,582 patients. 2,797 parturients of them were given peridural analgesia. In spite of the widespread use of this method of pain control during labor, the rate of vaginal operative deliveries in percentage terms did not change. The result corroborates the authors' assumption that an increase in the number of obstetric vaginal operations is not a necessary concomitant of lumbar peridural analgesia.

Anesthesia, Epidural↗
PubMed1979

[Psychomotor development of children born operatively by Caesarian section, vacuum or forceps in the period between 3 and 7 years (author's transl)].

In the period between 1966 and 1977 9,591 children were born at the UFK, Mannheim, and of these 1.008 were operative deliveries (10.5%). Out of these children, 99 of those delivered by section, 39 by forceps, 140 by vacuum and 67 spontaneous births were examined in an alphabetically determined group (R) for mental and motor development. The means used for the follow-up investigation were the Kramer-Binet Intelligence Test, and careful questioning of the parents on their children's early development. No connection between the type of delivery and intelligence quotient could be determined. A mean IQ of 114.4 was found for those delivered by section, 116.6 for those by forceps, and 117.7 for thos delivered by vacuum. The spontaneously-born children had an IQ of 108.7. The IQ results determined were correlated with the following data: EPH-gestosis, alteration in the child's heart sounds, protracted birth and Apga. No significant differences in the intelligence or any delayed motor development could be found in relation to the comparative group.

Adult↗