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PubMed2003

The effect of childbirth on pelvic organ mobility.

OBJECTIVE: To study the effect of child birth on pelvic organ mobility in a prospective observational study. METHODS: A total of 200 women were recruited early in their first ongoing pregnancy and examined by translabial ultrasound in the first/early second trimester, the late third trimester, and 2-5 months postpartum. Peripartal changes in the mobility of urethra, bladder, cervix, and rectal ampulla were correlated with labor and delivery data. RESULTS: A total of 169 women returned postpartum (84.5%). Highly significant increases in organ mobility on Valsalva were found after vaginal delivery (P <.001), with forceps causing the most marked changes. Length of second stage, especially active second stage, correlated with an increase in pelvic organ descent (P =.03 to P <.001). The influence of gestational age, length of first stage, and birth weight did not reach significance. CONCLUSION: Vaginal birth, in particular operative delivery, negatively affects pelvic organ support. This appears to be true for all three vaginal compartments. All forms of cesarean delivery were associated with relatively less pelvic organ descent. These findings may partly explain the protective effect of elective cesarean delivery for future symptoms of pelvic floor disorders.

Adult↗
PubMed1999

Birth weight of women with gestational diabetes.

OBJECTIVE: Epidemiological observations have suggested a relationship between type 2 diabetes and a low birth weight. However, there are many confounding variables and problems with retrospective data collection. Women with gestational diabetes mellitus (GDM), who are likely to develop type 2 diabetes in the future, may help clarify these observations. RESEARCH DESIGN AND METHODS: Consecutive women with GDM (n = 138) were included in the study if they had a singleton pregnancy delivered between 37 and 41 weeks of gestation, if they had themselves been born in the local hospital, and if their own delivery data were available. With respect to their own births, a matched group was obtained by considering the next female delivery of the same gestational age. RESULTS: For women with GDM, the mean (+/- 1 SD) birth weight was 3,293 +/- 493 g and the ponderal index was 27.0 +/- 2.4. Their values were not significantly different from the matched group, which had a birth weight of 3,315 +/- 460 g and a ponderal index of 27.0 +/- 2.5. After adjusting for the gestational age of delivery, the birth weight of women with GDM did not show a U-shaped distribution. CONCLUSIONS: After adjustment for the gestational age of delivery, women with GDM do not themselves have either a lower or higher birth weight than a matched group. These data suggest that women with GDM are either not a good surrogate for investigating the relationship between birth weight and type 2 diabetes or that correction for the gestational age of delivery removes the most important confounding variable. It is also possible that modern dietary changes may have altered the relationship.

Adult↗
PubMed1996

Second-trimester amniotic fluid or maternal serum interleukin-10 levels and small for gestational age neonates.

OBJECTIVE: To evaluate if interleukin-10 levels in either early second-trimester amniotic fluid (AF) or maternal serum can be utilized as a predictor of the subsequent occurrence of small for gestational age (SGA) infants after controlling for gestational age at delivery. METHODS: We identified patients who underwent genetic amniocentesis for standard genetic indications or maternal blood sampling for maternal serum alpha-fetoprotein (MSAFP)/triple screen between January 1992 and February 1995 with available follow-up delivery data. Small for gestational age was defined as birth weight less than the tenth percentile for gestational age. Control patients were matched for gestational age at delivery, maternal age, race, and parity with at least two controls for each study patient. We excluded patients with maternal immune disease, chronic hypertension, diabetes, asthma, congenital heart disease, multiple gestation, and fetuses with structural or chromosomal anomalies. Second-trimester AF and serum samples were assayed for interleukin-10. Potential confounding variables considered were MSAFP level, smoking history, pregnancy-induced hypertension, and neonatal gender. The interleukin-10 levels were normalized using natural log transformation for statistical analysis. Statistical analysis included chi 2, Fisher exact test, and analysis of variance, with P < .05 considered significant. RESULTS. From the AF data base, 18 patients (6%) delivered SGA neonates and were matched with 46 controls. From the maternal serum data base, 13 patients (7%) delivered SGA neonates and were matched with 45 controls. Neither AF nor maternal serum interleukin-10 levels were significantly different in patients subsequently delivering SGA neonates compared with controls (AF: median 21.0 pg/mL. [range 13.8-27.6] versus 17.5 pg/mL. [range 8.9-362.12], P = .18; serum: median 15.7 pg/mL [range 9.9-73.5] versus 18.7 pg/mL [range 9.7-71.7], P = .60, respectively). No significant differences were identified in gestational age at sampling, maternal smoking history, pregnancy-induced hypertension, or elevated MSAFP in patients delivering SGA neonates compared with controls (P > .05 for each). As expected, birth weight was significantly lower in patients delivering SGA neonates compared with controls (P < .001). CONCLUSION: Second-trimester AF or maternal serum interleukin-10 levels are not predictive of subsequent delivery of SGA infants.

Adult↗
PubMed2003

The maternity blues and Hong Kong Chinese women: an exploratory study.

BACKGROUND: The maternity blues have been studied world-wide and are generally regarded as a cross-cultural phenomenon. However, low prevalence rates of the blues have been reported recently in studies of Japanese women. The purposes of this study are, firstly, to establish whether the low prevalence noted in Japanese women is also found in another group of Asian women, that is, Hong Kong Chinese women, and secondly, to describe the manifestations of the blues in this group of women. METHOD: A prospective survey involving a convenience sample of 88 women, recruited on the first day after normal or operative vaginal delivery. Participants completed a blues self-rating scale (Stein's Daily Scoring System) every day for the first 7 days after delivery. Data were analysed mainly in terms of descriptive statistics. RESULTS: 39 (44.3%) women experienced an episode of the blues during the first week after delivery. The manifestations of the blues showed a typical peaking on the 5th postnatal day. LIMITATIONS: This is a short-term exploratory study. Further investigation is required into the factors influencing or precipitating the blues, particularly from the cultural perspectives of childbearing Hong Kong Chinese women. CONCLUSION: Hong Kong Chinese women experience the maternity blues in similar ways to those reported by studies of women in other countries and cultures, with the exception of those describing the blues in Japanese women.

Adolescent↗
PubMed2001

Obstetric complications in women with schizophrenia.

It is not known whether schizophrenic women have increased incidence of complications during pregnancy and delivery. Data from the Danish Medical Birth Register were used to compare 2212 births to 1537 schizophrenic women in Denmark with a random sample of all deliveries in Denmark during 1973-1993 (122931 births to 72742 women). The schizophrenic women had fewer antenatal care visits. They were at lower risk of pre-eclampsia, but tended to have lower Apgar scores. There were no other differences in the incidence of specific complications such as placenta previa, placental abruption, and abnormal fetal presentation. Schizophrenic women were at increased risk of interventions such as Cesarean section, vaginal assisted delivery, amniotomy, and pharmacological stimulation of labor. There were no important differences between the deliveries to schizophrenic women who gave birth before and after their first admission to a psychiatric department. These results show no evidence that schizophrenic women have a greater frequency of specific obstetric complications than non-schizophrenic women. Nevertheless, they are at increased risk for interventions during delivery.

Adult↗
PubMed1998

Maternal leisure-time exercise and timely delivery.

OBJECTIVES: This study investigated whether, in a general obstetric population, exercise in pregnancy affects the timeliness of delivery. The hypothesis was that maternal exercise would not raise the risk of preterm birth. METHODS: A community cohort of 557 prenatal patients was followed up until the time of delivery. Data were collected on exercise in each trimester: none, low-moderate (< 1000 kcal [4184 kJ]/wk in energy expenditure), or heavy (> or = 1000 kcal/wk). Timely delivery was adopted as an outcome criterion. Thus, in the analysis, a term birth was treated as optimal and survival techniques were used to estimate risks for both preterm and postdates delivery. RESULTS: No association was found between low-moderate exercise and gestational length. Heavier exercise appeared to reduce, rather than raise, the risk of preterm birth. The adjusted relative risk among conditioned heavy exercisers was 0.11 (95% confidence interval = 0.02, 0.81). After term, conditioned heavy exercisers delivered faster than nonexercisers. CONCLUSIONS: The most important finding was the lack of evidence that vigorous maternal exercise is a risk factor for preterm delivery. A promising finding was that conditioned heavy exercisers have timely deliveries.

Adult↗
PubMed1995

Carcinoma of the cervix: patterns of care studies: review of 1978, 1983, and 1988-1989 surveys.

PURPOSE: A review of the Patterns of Care Studies Process Survey data on carcinoma of the cervix conducted on patients in 1978, 1983, and 1988-89 was carried out to identify changes or trends in the demographics, evaluation, and treatment that might have occurred over this time period. METHODS AND MATERIALS: Patterns of Care Studies conducted surveys on patients treated by radiation therapy for cervical carcinoma in 1978, 1983, and 1988-89. These surveys have compiled demographic and treatment data on a total of 993 patients. There is outcome data for the 1978 and 1983 surveys, but not for the 1988-89 survey because follow-up has not been collected yet. The demographic and treatment delivery data on all three surveys has been reviewed and analyzed and is the subject of this study. RESULTS: There was no difference in the age distribution at the time of diagnosis of the patients in these surveys. The percentage of black patients remained constant in the three surveys, 19%, 17%, and 21%, respectively. The percentage of white patients was 76%, 78%, and 67%, but that of nonwhite/nonblack patients was 3%, 4%, and 12% (p < 0.001). The distribution of patients by stage was similar in the first two surveys. In the third survey, there was a decrease in the percentage of patients with Stage IA and IB (first = 35%; second = 38%; third = 29%) with a concurrent increase in Stage IIIA and IIIB patients (first = 20%; second = 18%; third = 26%). The surveys showed a major change in the pretreatment evaluation tests used. There was a progressive decrease in the use of intravenous pyelogram (IVP) (86 to 42%), barium enema (58 to 32%), cystoscopy for patients Stage IIB and higher (64 to 52%), and lymphangiography (18 to 14%). The use of abdominal or pelvic computed tomography dramatically increased from 6 to 70% between the first and third surveys. The use of 60Co units decreased from 35 to 2% from the first to the third survey [6 to 0% for short source-surface distance (SSD) 60Co units]. Point dose calculations for the intracavitary therapy increased from 78% in the 1978 survey to 95% in the third survey. As determined by the total dose delivered to the paracentral points, more patients (75.1%) were treated according to the Patterns of Care recommended guidelines in the 1988-89 survey than in the 1983 survey (63.6%). Chemotherapy was given to 12% of the patients undergoing radiation therapy during the period of the third survey, but these data are not available for the first and second surveys. CONCLUSION: Review of the Carcinoma of the Cervix Patterns of Care studies discloses significant changes in the demographics, patient evaluation, and radiation therapy techniques during the period of the studies. The potential impact of these changes on treatment outcome cannot be determined at this time until longterm follow-up for the 1988-89 survey is available, but improvements in the processes of care should lead to improvements in outcome.

Adult↗
PubMed1991

[Development of an electronic calculator for gestational age in prenatal care].

The development of a portable electronic gestation calculator enables the obstetrician for the first time to recall all relevant data for his daily routine work from an electronic memory. This is useful not only for the calculation of the duration of pregnancies or the determination of delivery data, but also includes all relevant information from ultrasound biometry of the fetus. This paper presents the experience with this new electronic device, 'Babycomp', and comments on its design, technical features, functions and performance. The device has been thoroughly tested especially with respect to its suitability for practical purposes. Compared with the widely used disk for pregnancy calculations, the 'Babycomp' has a wide range of advantages for all users working in the field of obstetrics and reproductive medicine.

Computers↗
PubMed2000

Vacuum extraction versus forceps for assisted vaginal delivery.

BACKGROUND: Proponents of vacuum delivery argue that it should be chosen first for assisted vaginal delivery, because it is less likely to injure the mother. OBJECTIVES: The objective of this review was to assess the effects of vacuum extraction compared to forceps, on failure to achieve delivery and maternal and neonatal morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: February 1999. SELECTION CRITERIA: Acceptably controlled comparisons of vacuum extraction and forceps delivery. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Ten trials were included. The trials were of reasonable quality. Use of the vacuum extractor for assisted vaginal delivery when compared to forceps delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument. REVIEWER'S CONCLUSIONS: Use of the vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal haemorrhages seen with forceps may be a compensatory benefit.

Extraction, Obstetrical↗
PubMed1996

Decreasing the cesarean section rate in a private hospital: success without mandated clinical changes.

OBJECTIVE: We analyzed the delivery statistics from our institution to describe a successful program of cesarean section delivery reduction and to help us understand what factors explained the reduction. STUDY DESIGN: A retrospective analysis of various cesarean section rates and risk factors from a prospectively collected delivery database of all patients delivered between May 15, 1988, and June 30, 1994. During the study period we instituted a program of increasing awareness, confidential provider feedback, more aggressive laboring techniques, and other clinical guidelines. The delivery data were divided into 6-month intervals and analyzed by chi 2 tables. RESULTS: The overall cesarean section rate fell from 31.1% to 15.4%. Similar reductions were noted in the primary (17.9% to 9.8%) and repeat cesarean section rates (13.2% to 5.7%). The primary cesarean section rate fall was accompanied by a drop in abdominal delivery for cephalopelvic disproportion and fetal distress. The repeat cesarean section rate is explained by a significant increase in trial and successful vaginal birth after cesarean delivery. No increase in maternal, fetal, or neonatal morbidity or mortality was observed. CONCLUSIONS: We have demonstrated that the cesarean delivery rate can be safely lowered in a private hospital without mandated clinical changes. Our data suggest that careful and detailed feedback can lead to improved clinical practice.

Cesarean Section↗
PubMed2004

Threshold retinopathy at threshold of viability: the EpiBel study.

AIM: To describe incidence, co-morbidity characteristics, and risk factors associated with threshold retinopathy of prematurity (ROP) in survivors with a gestational age (GA) of < or =26 weeks at birth. METHODS: Retrospective analysis of perinatal data of all inborn survivors in all perinatal centres of Belgium in the period 1999-2000 (EpiBel cohort) believed to be between 22 and 26 weeks GA at time of delivery. Data on survivors who did and survivors who did not develop threshold ROP were compared (chi(2), Mann-Whitney U) and logistic regression was performed. RESULTS: Of 303 admitted infants 175 (58%) were discharged alive. Incidence of major retinopathy (> or =stage 3) and of threshold ROP was 25.5% and 19.8% in survivors. Associated central nervous abnormalities were documented in six (17%) and associated chronic lung disease in 19 (54%) threshold ROP infants. Threshold ROP without additional morbidity characteristics at discharge was documented in 14 (40%) infants. Besides often reported risk factors, renal insufficiency (creatinaemia>1.5 mg/dl) was a risk factor to develop threshold ROP (p<0.0015) (chi(2)). Days of respiratory support (OR 1.02; 95% CI 1.002 to 1.039), number of transfusions (OR 1.118; 95% CI 1.030 to 1.214), and renal insufficiency (OR 3.31; 95% CI 1.344 to 8.196) remained independent risk factors to develop threshold ROP in this cohort in a stepwise logistic regression model (MedCalc). CONCLUSIONS: Incidence of threshold ROP is high at the limits of viability. Renal insufficiency is a risk factor to develop threshold ROP in this cohort.

Belgium↗
PubMed2005

Rate of increase in oxytocin dose on the outcome of labor induction.

OBJECTIVE: To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor. METHODS: A total of 120 pregnant women requiring induction of labor at term were randomly assigned to receive oxytocin at dosages increasing arithmetically or geometrically. Maternal demographics, labor delivery data, and newborn outcomes were compared. The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups (24.66+/-8.34 mU/min vs. 26.38+/-8.77 mU/min, P=0.24). Labor duration was significantly shorter in the geometric progression group (496.33+/-54.77 min vs. 421.34+/-63.91 min, P<0.001). There were no differences in the rates of cesarean sections, vaginal deliveries, or uterine hyperstimulation, or in neonatal outcomes. CONCLUSION: A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation, or newborn outcomes.

Chi-Square Distribution↗
PubMed2004

Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis.

OBJECTIVE: To define the role of suture closure of the subcutaneous dead space in preventing wound complications after cesarean delivery. DATA SOURCES: We searched MEDLINE, the Cochrane Database of Systematic Reviews, and the bibliographies of major texts and review articles. METHODS OF STUDY SELECTION: Only studies in which patients undergoing cesarean delivery were randomly assigned to closure of the subcutaneous space or to no closure were included. Each study was required to report on at least 1 of the following outcomes: wound infection, hematoma, seroma, or separation. The studies also reported "wound disruption," a combination of these outcomes which either explicitly stated or strongly implied the need for further wound care. Six studies meeting criteria were identified. TABULATION, INTEGRATION, AND RESULTS: Three studies included 875 patients with any subcutaneous thickness and noted a decrease in wound disruption with closure (relative risk [RR] 0.56; 95% confidence interval [CI] 0.36, 0.86). Two studies reported results from 181 patients with incision depth of 2 cm or less and noted no difference (RR 1.01; 95% CI 0.46, 2.20). Five studies reported results on 887 patients with wound thickness greater than 2 cm. Although only 1 study had a significant effect by itself, when results were combined, there was a significant decrease in wound disruption (RR 0.66; 95% CI 0.48, 0.91). This reduction seems to be largely a result of decreased wound seromas (4 studies, 852 patients, RR 0.42; 95% CI 0.24, 0.75). In women with wound thickness greater than 2 cm, subcutaneous closure resulted in a risk reduction of 6.2%, and 16.2 women would need subcutaneous closure to prevent 1 wound disruption (number needed to treat). CONCLUSION: Suture closure of subcutaneous fat during cesarean delivery results in a 34% decrease in risk of wound disruption in women with fat thickness greater than 2 cm.

Adipose Tissue↗
PubMed2004

Clinical manifestations and management of labor and delivery in women with factor IX deficiency.

Haemophilia is uncommon in females and little is known about the clinical manifestations and postpartum management of women with this disorder. Clinical characteristics of postpartum bleeding were evaluated in women with factor IX deficiency (FIX:C < 0.20 U mL(-1)), including two with haemophilia B and three carriers of haemophilia B, undergoing labour and delivery. Data were collected prospectively during routine outpatient comprehensive haemophilia care at the haemophilia Center of Western Pennsylvania and during inpatient management. Four of five women experienced postpartum bleeding, during six of 16 deliveries: the median haemoglobin was 10.7 g% and two required blood transfusion. Postpartum bleeding was significantly more common among those receiving fewer than 4 days of FIX replacement: six of 13 (46.1%) receiving fewer three or fewer days bled vs. none of three (0%) receiving six or more days treatment [P < 01 (Wilcoxon)]. Postpartum bleeding was not related to the route of delivery (P = 0.525), vaginal vs. Caesarean, nor the FIX level (P = 0.371; FIX > 0.05 U mL(-1) vs. < or =0.05 U mL(-1)). Compared with females with von Willebrand disease or FXI deficiency, females with FIX deficiency were more likely to experience postpartum bleeding (P = 0.008) and anaemia (P = 0.045); and they were less likely to experience menorrhagia (P = 0.065), but the latter did not reach significance. Postpartum bleeding is common in women with haemophilia B or carriers of haemophilia B, and treatment with factor replacement for at least 4 days of postpartum may prevent bleeding following delivery in such women.

Adult↗
PubMedDate not supplied

Nonobstetrical abdominal surgery during pregnancy in Women's Hospital.

OBJECTIVE: To determine if nonobstetrical abdominal surgery during pregnancy in Women's Hospital at the University of Southern California School of Medicine was associated with increased rates of preterm delivery or spontaneous loss. Preoperative diagnostic accuracy was also evaluated. METHODS: We performed a retrospective review of all cases of nonobstetrical abdominal surgery in our institution during a 7-year period from November 1991 to November 1998. RESULTS: One hundred-six cases of nonobstetrical abdominal surgery were identified. Eighty-eight women underwent laparotomy and 18 had laparoscopic abdominal surgery. Seventy-three women had emergent surgery and 31 had elective surgery. Seventy-six percent (80/106) of subjects had the same preoperative and postoperative diagnoses. We obtained delivery data for 62 of 106 (59%) subjects. Eleven of 62 (18%) subjects who had nonobstetrical abdominal surgery during pregnancy delivered preterm (<37 weeks' gestation). This was not significantly different from the institutional preterm delivery rate of Women's Hospital (8999/56305 [16%]) (P = 0.84). Two of 106 (2%) women experienced spontaneous pregnancy loss following surgery; both occurred in the second trimester. CONCLUSIONS: Nonobstetrical abdominal surgery during pregnancy in Women's Hospital was not associated with higher frequencies of preterm deliveries or spontaneous losses than our institutional rates.

Abdomen↗
PubMed2004

In the puerperium, primiparae exhibit higher levels of anxiety and serum peptidase activity and greater immune responses than multiparae.

BACKGROUND: Delivery is accompanied by increases in anxiety levels that are significantly related to an activation of the inflammatory response system (IRS), as indicated by increases in the serum concentrations of interleukin-6 and the interleukin-1 receptor antagonist (IL-1RA) and increases in the activity of prolyl endopeptidase (PEP), a cytosolic endopeptidase that cleaves peptide bonds on the carboxyl side of proline in behaviorally active neuropeptides involved in anxiety. Primiparae may show an immune responsivity differing from that in multiparae. The aims of this study were to examine whether there are differences in anxiety levels, the IRS, and serum PEP values between primiparae and multiparae before and after delivery. METHOD: We administered the Spielberger State-Trait Anxiety Inventory (STAI) to and assessed serum IL-1RA and soluble CD8 (sCD8) concentrations and serum PEP activity in 48 primiparae and 48 multiparae at the end of term and 1 and 3 days after delivery. Data were gathered in 1996 and 1997. RESULTS: We found that in primiparae (p =.001), but not in multiparae (p =.6), there was a significant increase in the STAI score 3 days after delivery and that primiparae had significantly higher STAI scores than multiparae 3 days after delivery (p =.01). Primiparae showed significantly higher serum IL-1RA levels than multiparae 1 (p =.003) and 3 (p =.02) days after delivery, but not before delivery. Primiparae also had lower serum sCD8 and higher serum PEP activity than multiparae before and after delivery. CONCLUSIONS: The results suggest that primiparae suffer greater anxiety and have a different neuroimmune responsivity than multiparae and that the increased anxiety levels in primiparae may be related to changes in the IRS and serum PEP activity.

Adult↗
PubMed1998

[Current practices in obstetrical analgesia in German university clinics. Results of a 1996 survey. Part 2].

UNLABELLED: Obviously there is a world-wide trend towards regional analgesia for pain relief during delivery. Data on the current practice in Germany are lacking. METHODS: In 1996 questionnaires on obstetric anaesthesia and analgesia were mailed to all university departments of anaesthesia. RESULTS: All 38 university hospitals with obstetric units replied (100%). Mean annual delivery rate was 1156. Epidural analgesia (EA) (n = 22), intramuscular injection of opioids (n = 18), and non-opioids as a suppository (n = 17) were often used for pain relief during labour. Intravenous injections (n = 12) or pudendus anaesthesia (n = 7) were practised as well. Entonox (N2O/O2), paracervical blocks or transcutaneous electrical stimulation (TENS) was rarely used. EA for relief of labour pain was offered in all university hospitals. Twelve of them had an epidural rate of less than 10%, in nine the rate was 10-19%, in eight hospitals 20-29% and 30% or more in nine. Indication for EA was a demand by the parturient (n = 34), by the obstetrician (n = 26) or the midwife (n = 18), predominantly because of prolonged labour (n = 32) or significant pain (n = 21). Half of the university departments used an epidural combination of local anaesthetics (bupivacaine) and opioids (sufentanil (n = 12) and/or fentanyl (n = 9)). In all but one department the application of an epidural catheter was performed by anaesthesiologists exclusively. In some hospitals obstetricians (n = 10) or midwives (n = 4) were allowed to give epidural top-up injections. Of the 38 university departments 11 had an anaesthesiologists on duty 24 h a day responsible for the obstetric unit exclusively. CONCLUSION: In 1977, 14 of 18 university departments of anaesthesiology offered epidural analgesia for parturients. This option was available in all university departments in 1996. A mean rate of 10-20% epidurals for vaginal delivery is well within the limits reported from other countries, whereas the rate of regional anaesthesia for scheduled caesarean section (40%) still is rather low in Germany, as reported in part 1 of this survey (Anaesthesist 1998;47:59-63).

Adult↗