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At least 811 records · Page 45Linked to original sources
PubMed1998

Maternal health after childbirth: results of an Australian population based survey.

OBJECTIVE: To describe the prevalence of maternal physical and emotional health problems six to seven months after birth. DESIGN: Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth. PARTICIPANTS: All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death. RESULTS: The response rate was 62.5% (n = 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (43.5%), sexual problems (26.3%), haemorrhoids (24.6%) and perineal pain (21%); 16.9% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.69 [95% CI 3.2-6.8]), sexual problems (OR 2.06 [95% CI 1.4-3.0]), and urinary incontinence (OR 1.81 [95% CI 1.1-2.9]). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma. CONCLUSION: Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.

Delivery, Obstetric↗
PubMed2005

Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction.

OBJECTIVE: The risk of obstetric brachial plexus palsy (OBPP) is increased in infants delivered instrumentally. The aim of this study was to identify risk factors for OBPP and to evaluate the association between possible risk factors linked to the duration of the vacuum extraction procedure and the subsequent risk. METHODS: A population-based retrospective design was adopted. Using a national registry of operative vaginal deliveries linked to the Medical Birth Registry in Sweden, we evaluated by univariate and multiple logistic regression analyses the risk factors for OBPP in 13,716 women delivered by vacuum extraction. The variables assessed in the multiple logistic regression analysis were shoulder dystocia, fetal birth weight of 3,999 g or greater, fundal pressure, number of tractions, vacuum application time, parity, vacuum silicone cup, epidural anesthesia, and fetal head at the level of the ischial spines at vacuum application time. RESULTS: Obstetric brachial plexus palsy was recorded in 153 (1.1%) infants. The following variables increased significantly the risk of OBPP in the newborn: shoulder dystocia (odds ratio 16.0; 95% confidence interval 8.9-28.7), fetal birth weight of 3,999 g or greater (7.1; 4.8-10.5), and administration of fundal pressure (1.6; 1.1-2.3). The probability of the risk of OBPP in vacuum-assisted deliveries increased in relation to vacuum extraction time (minutes). CONCLUSION: Shoulder dystocia in the setting of vacuum extraction is a prominent risk factor for OBPP in the newborn. The risk of OBPP increases with the time required for vacuum extraction. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed1993

Caesarean section rates in an African country.

The use of caesarean section (C.S.) has been analysed in the 12 hospitals of the Midlands Province of Zimbabwe during a 2-year period. Maternal mortality rate, perinatal mortality rate, low birthweight rate, percentage of high risk pregnancy, C.S. rate and instrumental delivery rate have been extracted for each hospital. The rate of C.S. delivery varied between 2.2 and 16.8 per 100 deliveries but was not correlated with the number of high-risk pregnancies. Increased use of C.S. was not linked to better perinatal results. An important determinant of the C.S. rate appears to be the physician and the ratio between the rate of instrumental deliveries (ID) and C.S. differentiated the 12 hospitals into two groups. Although there was no difference in the number of high risk patients in these two groups, outcomes were much better in the hospitals with a high ID rate than in the hospitals with a high C.S. rate, suggesting that attitudes of medical staff can influence both the mode of delivery and the perinatal outcome in a developing country.

Adolescent↗
PubMed2002

The economic costs of alternative modes of delivery during the first two months postpartum: results from a Scottish observational study.

A study was conducted to estimate the economic costs of alternative modes of delivery during the first two months postpartum. Hospital and community health service utilisation data for 1242 women were extracted from self-completed questionnaires, medical case notes and computerised hospital discharge records. Unit costs (1999-2000 prices) were collected for each item of resource use and combined with resource volumes to obtain a net cost per woman. There were significant differences in initial hospitalisation costs between the three mode of delivery groups (spontaneous vaginal delivery pounds sterling 1431, instrumental vaginal delivery pounds sterling 1970, caesarean section pounds sterling 2924, P < 0.001). There were also significant differences in the cost of hospital readmissions, community midwifery care and general practitioner care between the three mode of delivery groups. However, total post-discharge health care costs did not vary significantly by mode of delivery. Total health care costs were estimated at pounds sterling 1698 for a spontaneous vaginal delivery, pounds sterling 2262 for an instrumental vaginal delivery and pounds sterling 3200 for a caesarean section (P < 0.001). It is imperative that hospital and community health service providers recognise the economic impact of alternative modes of delivery in their service planning.

Cesarean Section↗
PubMed1976

[Breech presentation and its significance (author's transl)].

From 1959 to 1975, 1060 (3.6%) breech presentations were found among 29,463 infants. The breech deliveries from May 1, 1959 to December 31, 1965 were compared with those from January 1, 1966 to December 31, 1975. Among the 3.6% breech deliveries there were 47% male and 53% female. There were more primigravida breech deliveries in both groups. The mean age of the mothers was 25.4 years for primigravidas and 29.4 years for multiparas. There was a maternal mortality of 0.2% (2 cases) in breech delivery. 29% of the breech deliveries were premature deliveries. There was a strickingly high incidence of frank and full breech deliveries among all patients. Knee presentations were rare. Delivery was primarily accomplished with the Bracht manoeuver in over 80% of the cases. Complete breech extractions decreased and the incidence of Caesarean Sections rose from 6% in the first group to 21% in the second group of patients. During the past 3 years the Caesarean Section rate was approximately 30%. Perinatal complications in the breech deliveries compare well to those reported in the literature. Of 750 mature infants (70.8%), 12 died (1.6%). Discounting children with congenital malformations and intrauterine stillbirth there remained 5 deaths from breech deliveries (0.7%). Of 1032 breech deliveries with a birth weight of 1000 grams or over, 74 infants (over all perinatal mortality 7.2%) died. 110 infants of all breech deliveries had a birth weight of less than 2500 grams (prematurity rate 29.2%). Of 102 cases of perinatal mortality in breech deliveries including those below 1000 grams 90 (88.2%) were premature. Of those 90 premature deaths, 28 infants were less than 1000 grams. 25 infants showed fetal congenital abnormalities. The corrected perinatal mortality of the premature deliveries was therefore 11.9%. The rate of birth trauma was 6.3% in the first group and 2.7% in the second group.

Adult↗
PubMed2002

Assisted breech delivery, is the art fading?

OBJECTIVE: To review the modes of breech delivery over a 5 year period in Khamis Civil Hospital, Khamis Mushayt, Kingdom of Saudi Arabia, and to evaluate the trend and associated complications. METHODS: Relevant data was extracted from the delivery room records of all women delivered in Khamis Civil Hospital, Khamis Mushayt, Kingdom of Saudi Arabia, from 1st January 1996 through 31st December 2000. Available data was analyzed. RESULTS: There were 375 breech deliveries, constituting 2.8% of the entire deliveries in the hospital. Eighty-two percent of the breeches were delivered by cesarean section while 18% had assisted vaginal delivery (p=0.0193). Amongst 72 primigravidae breeches, 68 (94.4%) were delivered by cesarean section while 238 (78.5%) out of 303 multigravidae were delivered by cesarean section. There were 2 unexplained neonatal deaths among the vaginal delivery group in multigravidae. Cesarean delivery was associated with less morbidity compared to vaginal delivery. CONCLUSION: This study has demonstrated a significant increase in delivery of breeches by cesarean section and the resultant drop, in the number available for assisted breech delivery. Less obstetricians will therefore be exposed practically to the art of assisted breech delivery. Most practicing obstetricians seem to be more inclined towards delivering breeches by cesarean section. If this trend continues, the art of assisted breech delivery may fade.

Breech Presentation↗
PubMed2006

Impacts of operative delivery for the first twin on neonatal outcomes in the second twin.

We assess the impacts of operative delivery for the first twins with vertex presentation on neonatal outcomes in second twins using the 1995 to 1997 twin registry data of the United States. A total of 102,554 eligible twin pairs with vertex presentation for the first twin were included in the analysis. Of these, 50,748 (49.5%) first twins had a normal vaginal delivery, 43,504 (42.4%) were delivered by cesarean section, and 8302 (8.1%) were delivered by vaginal operation (vacuum extraction or forceps). In term twins, the risks of asphyxia-related mortality (odds ratio [OR], 3.08; 95% CI, 1.07 to 8.45), newborn injury (OR, 2.10; 95% 1.39 to 3.12), low Apgar score at 5 minutes (OR, 1.49; 95% 1.24 to 1.78), and mechanical ventilation use (OR, 1.34; 95% 1.20 to 1.51) were increased in the second twins whose co-twins were delivered by vaginal operation compared with those whose co-twins who had normal vaginal delivery. In contrast, the risks of asphyxia-related mortality (OR, 0.55; 95% 0.17 to 1.57), newborn injury (OR, 0.20; 95% 0.11 to 0.34), low Apgar score at 5 minutes (OR, 0.51; 95% 0.44 to 0.60), and mechanical ventilation use (OR, 0.77; 95% 0.71 to 0.83) were decreased in the second twins whose co-twins were delivered by cesarean section compared with those whose co-twins had a normal vaginal delivery. In conclusion, vaginal operative delivery for the first twins is related to the adverse neonatal outcomes of their co-twins, whereas cesarean delivery for the first twins is associated with the beneficial neonatal outcomes of their co-twins.

Apgar Score↗
PubMed1986

[Management of full term breech presentation--criteria for safe vaginal delivery (without extraction of the breech head)].

It is very important to appraise cephalo-pelvic disproportion (CPD), and to predict the necessity of extraction of the after-coming head on full-term breech presentation. Subjects were 47 cases of full-term breech presentation which delivered at our hospital during the 5-year period from 1979 to 1983. They were divided into the following groups: group A Assisted breech delivery. group B Extraction of after-coming head. group C Abdominal delivery for secondary inertia. In each case we subtracted the fetal occipitofrontal diameter from the individual pelvic diameter and compared the results for groups A and B. There were significant differences between groups A and B in the mean values (cm) for the following: True antero-posterior diameter of the wide; 1.341 +/- 1.009 and 0.380 +/- 0.379 (p less than 0.001). Antero-posterior diameter of the Fukushima's wide; 2.005 +/- 0.906 and 0.860 +/- 0.502 (p less than 0.01). Posterior-sagittal diameter of the wide; -5.300 +/- 1.026 and -6.020 +/- 0.340 (p less than 0.05). Antero-posterior diameter of the midpelvis; 1.414 +/- 1.035 and -0.110 +/- 0.718 Posterior-sagittal diameter of the midpelvis (Caldwell-Moloy); -5.759 +/- 1.041 and -6.560 +/- 0.573 (p less than 0.05). Posteriol-sagittal diameter of the midpelvis (Thoms): -6.173 +/- 1.083 and -7.430 +/- 0.750 (p less than 0.01). Furthermore, there were also significant differences between groups A and C: The margins of safety values for each pelvic diameter (cm) were as follows: Antero-posterior diameter of the midpelvis; (13.1): Posterior-sagittal diameter of the midpelvis (Thoms); (5.5): Inter-spinous diameter; (11.0): Inter-tuberous diameter; (11.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed2006

Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: was this the Hawthorne effect?

BACKGROUND: The incidence of birth trauma and birth asphyxia related to instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied). OBJECTIVES: The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect. METHOD: To compare the hospital obstetric statistics among the pre-study period (1998-1999), the study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to instrumental deliveries, the instrumental delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed instrumental delivery, the incidence of attempted instrumental delivery in the operating theatre, and incidence of direct second-stage Caesarean sections. RESULTS: The incidence of birth trauma and birth asphyxia related to instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The instrumental delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively). CONCLUSION: A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period.

Asphyxia Neonatorum↗
PubMed1982

Analgesia and satisfaction in childbirth (the Queen Charlotte's 1000 Mother Survey).

Maternal satisfaction with the experience of childbirth was investigated in 1000 women having a vaginal delivery of a live child. Effective pain relief did not ensure a satisfactory birth experience. Epidural block produced the most effective analgesia but there were more dissatisfied women among the epidural patients than among those who did not receive this analgesia (p less than 0.05). Bad experience scores were evaluated one year later and were clearly related to a forceps delivery and long labour, both of which were more common in the epidural group. The desirability of an "epidural on demand" service should be tested against an "epidural when necessary" service.

Analgesia↗
PubMed1991

[Opiate analgesia in labor--use of nalbuphine in comparison with administration of the combination Dolantin/Atosil/Haldol].

Since July 1, 1990, Nalbuphine has been used as an obstetric analgesia at the Municipal Women's Hospital in Cologne-Holweide. The following differences were found between 2 groups of 122 patients each, one of which received Nalbuphine and the other a socalled cocktail, a combination of dolantin, haldol, and atosil. The number of spontaneous births in the Nalbuphine group was higher and the number of Caesarean sections and vagino-operative births were lower in comparison to the cocktail group. The pH-level of the arterial umbilical cord was higher in the Nalbuphine group, which can be explained by less stress on the child during birth. Overall, the post partum irregularities were less in the Nalbuphine group, whereas 6 children in the cocktail group had respiratory adaptation disturbances.

Analgesia, Obstetrical↗
PubMed1984

Epidural analgesia and instrumental delivery.

In patients given epidural analgesia who had singleton vertex vaginal deliveries the normal delivery rate was 57%, compared to 80% in all this group. The increase in instrumental delivery rate could partly be accounted for by parity (primigravidae are over-represented in the epidural group), by obstetric and medical indications for epidurals, and by the need for sitting top-ups to relieve perineal pain. There remained a small population of patients in whom epidurals may have contributed to the need for instrumental delivery.

Anesthesia, Epidural↗