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PubMed2001

Hemostatic problems before, during and after delivery.

Normal pregnancy and childbirth are known to be associated with marked changes in the coagulation and fibrinolytic systems. Generally, enhancement of clotting activity persists to prevent the risk of major hemorrhage. Hemostatic problems, either associated with a specific complication of pregnancy and labor or due to a hereditary or acquired bleeding diathesis or thrombophilias, present a significant cause of maternal and neonatal morbidity and mortality. This article reviews hemostatic disorders in pregnancy and the peripartal period from the standpoint of the obstetrician.

Blood Coagulation Disorders↗
PubMed1999

Preventing neonatal group B streptococcal disease: cost-effectiveness in a health maintenance organization and the impact of delayed hospital discharge for newborns who received intrapartum antibiotics.

OBJECTIVES: To estimate the cost and health benefits of implementing a risk factor-based prevention strategy for early-onset neonatal group B streptococcal (GBS) disease, using baseline assumptions and costs from a health maintenance organization. With the risk factor-based strategy, intrapartum antibiotics (IPAs) would be provided to women with fever, prolonged rupture of membranes, or preterm labor. A second objective was to determine the impact of an increased length of stay for well term infants with mothers who received IPAs. METHODS: We used decision analysis to compare the costs and benefits of the prevention strategy with usual obstetric practice for a cohort of 100 000 women and their newborn infants. We derived baseline values from a previous study based on chart review and automated cost data from a health maintenance organization in Northern California. In sensitivity analyses, we varied baseline assumptions, including additional costs for observing well term infants who received IPAs. RESULTS: If adherence to guidelines were 100%, 17% of mothers would receive IPAs at a cost of $490,000; $1.6 million would be saved by preventing 66 GBS cases (64% reduction). The net savings would be $1.1 million and 61 life-years. The net cost is sensitive to the cost of caring for well infants who received IPAs. If each term infant of a mother who received IPAs had 1 more day of observation than other term infants, there would be a net cost of $8.1 million; the cost per GBS case prevented would be $120,000 and the cost per life-year saved would be $130,000. CONCLUSIONS: Implementation in a health maintenance organization of a risk factor-based strategy to prevent neonatal GBS disease can prevent substantial disease and be cost saving. However, if the length of hospital stay were extended among well term infants whose mothers received IPAs, the strategy would be relatively costly compared with other medical interventions.

Anti-Bacterial Agents↗
PubMed1977

Value of external version in fetal malpresentation in combination with use of ultrasound.

During 1969--1974 six hundred and forty-nine external versions were attempted during the last trimester on 491 mothers with fetal malpresentation. The procedure was monitored with ultrasound in 1969--1974. Most of attempts (70.0%) were made during the 32nd-36th weeks. The final version rate after one or more attempt was 76.2%, being lower (67.0%) in nulliparous than parous women (84.6%). The incidence of breech presentation at birth decreased from 4.5 to 2.9% (p less than 0.001). The most serious complication was one premature labor but the infant survived. The perinatal mortality was 2.0% and, after excluding abnormal infants, 0.8%. The combination of external version and the use of ultrasound is a safe method which avoids hazardous vaginal breech delivery and is recommended in obstetric practice.

Apgar Score↗
PubMed1986

Ultrasonic assessment of cervix in 'at risk' patients.

One hundred and fifteen women were considered to be at risk of cervical incompetence, judging from their previous history. They were scanned serially from the first trimester to 32 weeks of gestation. Of the 115, 75 women were found to have defective cervix, as assessed on the basis of its length, its overall width and the width of the cervical canal at the level of the internal cervical os, and herniation of the amniotic membrane, with or without fetal parts, into the cervical canal. Sixteen of the 75 women with ultrasonically diagnosed cervical incompetence aborted, 40 needed cervical cerclage, 24 gave birth premature (24 to 34 weeks). Of the 115 women, 40 did not have ultrasonic evidence of cervical incompetence and only one patient gave birth at 36 weeks' gestation, while 39 patients gave birth between 37 and 42 weeks. These 40 women would have had cervical cerclage on the basis of clinical history alone. Ultrasound is an objective method of diagnosing the incompetent cervix and also helps to avoid unnecessary cerclage operations on the basis of history alone.

Abortion, Spontaneous↗
PubMed1999

Anaphylaxis in labor secondary to prophylaxis against group B Streptococcus. A case report.

BACKGROUND: Two strategies have been recommended by the Centers for Disease Control and Prevention and approved by the American College of Obstetrics and Gynecology to help prevent group B streptococcal disease in the newborn. Both involve using penicillin in labor. However, the potential for allergic and even anaphylactic reactions to penicillin exists. CASE: A patient was treated for risk factors for group B Streptococcus in labor and suffered a serious anaphylactic reaction to penicillin; it resulted in an emergency cesarean section. Although the patient and infant were eventually discharged, the patient developed disseminated intravascular coagulation and suffered acute tubular necrosis that required dialysis. CONCLUSION: Prophylaxis against group B streptococcal sepsis is of proven benefit, but the possible harm to the mother and fetus from treatment with penicillin must be recognized.

Adult↗
PubMed1975

[Possibilities in modification of the risk to the child in multiple pregnancy and labor].

A comparison of twin deliveries from 1966 to 1971 (140 = 1,23%) and from 1972 to 1974 (65 = 1,07%) indicates a decrease of the uncorrected perinatal mortality from 10,35% to 6,15% caused by early diagnosis, gestation prolonging measures, diagnosis of placental insufficiency and management of delivery. Concerning the first twin the decrease of perinatal mortality was more evident from 7,86% to 1,54% compared with the second twin from 12,86% to 10,77%. Nevertheless the following statement can be made: up to 1971 perinatal mortality was mainly a problem of prematurely born infants; it is changed now to a problem of antenatal mortality of small for date infants. Prematurely birth and mortality of twins may be well influenced by: 1. Early diagnosis. 2. Widely used hospitalisation, beginning from 28 th week of gestation. 3. Widely used cervix-cerclage and uterotocolysis. 4. Intensive antenatal care. 5. Intranatal intensive care of both infants (cardiotocography, blood gas analysis). 6. Limitation of the interval to 5 to 10 minutes. 7. Widened caesarean section indication (breech presentation, small for date infants).

Cesarean Section↗
PubMed1976

[Deliveries in foreign women (author's transl)].

The question is to be answered whether the delivery in foreign women has in any case to be valued as riskful birth. The development of deliveries in 1941 foreign women from 1968-1973 is therefore analysed and compared with 9009 deliveries in German women. The share of deliveries in foreign women increased from 3% in 1968 to 32% in 1973. Wifes from Turkey and Jugoslavia are prevailing (68,1% and 19,5%). A significant moving of parity to a higher number of children can be noticed in foreign women. The incidence of operative deliveries in foreign women amounting to 12,5% was 5% lower than in German women. The incidence of sectio amounted to 9.4% in German women and to 7.5% in foreign women. The rate of premature births in foreign women figured up to 9,5% surpassed the rate of premature births in German women by 1%. The comparison of uncleared as well as of cleared perinatal mortality did not show any statistically significant difference. Merely the mortality of sectio-children amounting to 6.9% was significantly higher in foreign women than in German women with 3.7% - owing to the accumulation of vital indications in caesarean sections. Authors come to the conclusion that based on their material examined deliveries in foreign women cannot be juged as riskful births. Particularities in foreign deliveries are specially indicated.

Cesarean Section↗
PubMed1976

[Influence of electronic monitoring of the fetus on the frequency of surgery and on the status of the newborn infant].

In the years from 1971 to 1974 the rate of fetal monitoring of high risk deliveries rose from 3.0% to 23.7%. In this time our clinic become a center of high risk pregnancies (reproductive failure and prematurity). By this way we could not show a decrease of the perinatal and intranatal mortality. The increase of caesarean sections from 3.0% (1968) to 6.0% (1974) was caused by the increasing of high risk patients. Fetal monitoring is not a cause for rising of operative frequency. By means of fetal monitoring the Apgar score of the newborns from mothers with severe diseases is not significant worse than from newborns of mothers with more easy diseases.

Apgar Score↗