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PubMed1999

Serum transferrin receptors in detection of iron deficiency in pregnancy.

A prospective hospital-based study was conducted to evaluate the efficacy of serum transferrin receptors in the detection of iron deficiency in pregnant women. The iron status of 100 pregnant women with single uncomplicated term pregnancies in the first stage of labor was established using standard laboratory measures. These included complete hemogram, red cell indices, serum iron, percent transferrin saturation, and serum ferritin. In addition, serum transferrin receptor (STFR) was estimated. The results of 81 women with complete laboratory profiles were analyzed. Thirty-five (43.2%) women were anemic (hemoglobin <11 g/dl). Hemoglobin (Hb) showed a significant correlation with MCH, MCHC, serum iron, and percent transferrin saturation, suggesting that the anemia was likely to be due to iron deficiency. The mean STFR level was 18.05+/-9.9 mg/l in the anemic women and was significantly raised (p<0.001) compared with that of the nonanemic women. STFR correlated significantly with Hb (p<0.001), MCH (p<0.05), MCHC (p<0.01), serum iron (p<0.01), and percent transferrin saturation (p<0.01) and also showed a highly significant correlation with the degree of anemia. Serum ferritin in these women did not correlate with Hb, and only 54.4% of the women had levels <12 ng/ml, which does not reflect the true prevalence of iron deficiency. Serum transferrin receptor estimation is thus a useful measure for detecting iron deficiency in pregnancy.

Adult↗
PubMed2000

The impact of early amniotomy on mode of delivery and pregnancy outcome.

OBJECTIVE: To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction. STUDY DESIGN: The study population consisted of 60 consecutive parturients induced by early amniotomy. The two comparison groups were 147 women admitted with term PROM and 65 patients induced by oxytocin. All study participants were evaluated prospectively and had unfavorable cervical scores. RESULTS: The duration of the first stage of labor was significantly longer in the PROM group (987.8 +/- 572.3 min) as compared with the early amniotomy group (615.0 +/- 389.6 min) and the oxytocin induction group (650.9 +/- 349.5 min, P<0.001). Higher rates of CS were found in the study group (26.7%) as compared to the controls (11.6% in the PROM and 16.9% in the oxytocin groups, p=0.012). Neonatal outcome was similar in all groups. A stratified analysis comparing the risk of CS while controlling for a previous one did not show a significant difference between the early amniotomy and the oxytocin administration groups. CONCLUSIONS: Early amniotomy is associated with a higher rate of CS. While controlling for a previous CS, both ways of induction were comparable. In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores.

Adult↗
PubMed1977

Evaluation of an impedance measurement technique for uterine contraction recording.

An electronic system for the detection of uterine contractions by impedance measurement was evaluated in 30 subjects during the first stage of labor. The advantage of the system was patient comfort and ease of application of the recording electrodes. Simultaneous recordings of uterine contraction activity with conventional extra- or intra-uterine recording systems were made. The available evidence from this study indicated that 82 to 84% of the uterine contractions were accurately detected and that the onset and end of each uterine contraction is a reliable parameter of impedance measurement.

Adolescent↗
PubMed1980

Total uterine impulse and cervical resistance at parturition.

Resistance to the passage of the fetus during parturition has been estimated indirectly by calculation of the active contraction area during the first stage of labor until the cervix reaches a dilatation of 5 cm--the period of cervical resistance. Parturients with a high total uterine impulse in this period were studied. Two different patterns of cervical resistance with corresponding clinical pictures were found. Type I had a high frequency of cesarean sections with a good correlation to the resistance. With high resistance there also was a tendency to low Apgar scores at 1 minute. Type II had normal 1 minute Apgar scores and only vaginal deliveries.

Apgar Score↗
PubMed1982

Pregnancy following cervical conization.

The effect of cone biopsy for cervical intraepithelial neoplasia on subsequent fertility and pregnancy was evaluated for 314 reproductive age women. Excluding patients lost to follow-up and those who had therapeutic hysterectomy, two study groups totaling 166 patients were obtained. The first consisted of 105 patients who did not become pregnant following conization. We found no evidence of secondary infertility caused by cervical conization. The second group of 61 patients achieved 88 pregnancies following conization. Comparison of these pregnancies with the outcome of 106 pregnancies by these same women prior to conization showed no effect of the operation on spontaneous abortions, preterm delivery, or cesarean section rates. The sole sequela of conization was to alter the duration of the first stage of labor.

Abortion, Spontaneous↗
PubMed1987

Spontaneous rupture of the membranes, functional dystocia, oxytocin treatment, and the route of delivery.

The details of clinical management were examined in 96 nulliparous patients with functional dystocia who had spontaneous rupture of the membranes before admission and were treated with oxytocin in the first stage of labor. It was our hypothesis that if the allegedly "high" rate of cesarean sections was the result of mediocre or flawed practices, these should be most evident in patients delivered abdominally. A group of 59 patients delivered vaginally were compared with 37 patients delivered by cesarean section. The means of many variables were not statistically different. The cesarean section group was characterized by smaller stature, a lesser cervical dilatation rate both before and after oxytocin administration, a larger maximum oxytocin dose, a longer period of oxytocin administration, more frequent cessation of oxytocin administration or dose reduction because of hypercontractility or an abnormal fetal heart rate or both, and a higher incidence of intra-amniotic infection. We conclude that the decision to perform cesarean section in nulliparous women with functional dystocia arises from disabilities of the patient and not from differences in the application of our management principles, services, or treatments.

Cesarean Section↗
PubMed1991

Management of severe preeclampsia detected in early labor by prostaglandin A1 or dihydralazine infusions.

The presence of severe pregnancy-induced hypertension at the onset of labor requires therapy with a potent hypotensive agent. Prostaglandin A1 is a powerful vasodepressor that augments renal blood flow and glomerular filtration and possesses antiplatelet aggregator and oxytocic properties. A continuous intravenous infusion of prostaglandin A1 (40 to 50 micrograms/min) or dihydralazine (35 to 50 micrograms/min) was administered to 20 women with severe preeclampsia (10 in each group). The induced hypotensive response was similar with both drugs but the maximum reduction in blood pressure was achieved sooner with dihydralazine (4 hours) compared with prostaglandin A1 (7.5 hours). The more gradual hypotensive response is probably less dangerous on placental perfusion than a sudden change. Moreover, the oxytocic property of prostaglandin A1 shortened the time to delivery, which constitutes another potential advantage.

Blood Pressure↗
PubMed1982

The transcutaneous PO2 measurement as an additional evaluation index to the physiological and pathological conditions under delivery.

Transcutaneous PO2 was continuously recorded from 17 newborns sub partu by normal deliveries and four cases with umbilical cord complications. These data were correlated with the corresponding fetal heart rate alterations and the maximum of contraction directly and 30 s thereafter. During the course of delivery three stages are differentiated: first stage of labor, full cervix dilatation, second stage of labor. The statistical evaluation succeeded in the X2-test (P less than 0.01). Deriving from this result the tcPO2 measurement is an additional aiding procedure beside the cardiotocographic control for subpartal supervision.

Female↗
PubMed1984

Intrapartum rupture of uterus diagnosed by ultrasound: a case report.

A case of ruptured uterine scar of a previous cesarean section diagnosed by ultrasound is presented. Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.

Adult↗
PubMed1989

Electronic fetal heart rate monitoring during cesarean section in cases of fetal distress.

Twelve fetuses in whom the diagnosis of fetal distress was made during first stage of labor were included in the study. All 12 patients underwent urgent cesarean section during which fetal heart rate (FHR) was recorded continuously. In 50% of the cases, marked improvement of FHR was registered early in the course of the operation. Improvement in fetal status is attributed to adequate oxygenation and cessation of uterine activity.

Cesarean Section↗
PubMed1994

Epidural anesthesia in early compared with advanced labor.

OBJECTIVES: To examine whether continuous lumbar epidural analgesia administered in the early phase of labor leads to an increased incidence of instrumental vaginal deliveries. METHODS: In a retrospective analysis we have studied 563 consecutive term cephalic vaginal deliveries where an epidural was given for pain relief in labor. The type of delivery was compared in two groups. In Group 1 epidurals were given when the cervix was 3 cm or less dilated; in Group 2 when they were greater than 3 cm dilated. RESULTS: There was no difference in the incidence of instrumental deliveries in the two groups. Other variables including station of the fetal head, premature rupture of membranes, meconium, and administration of pitocin and pethidine did not effect these results. CONCLUSIONS: There is no justification in delaying epidural analgesia in labor when it is clinically indicated.

Anesthesia, Epidural↗
PubMed1982

Elective fetal monitoring and obstetrical operative frequency.

This paper reports on cardiotocographic findings after the introduction of elective fetal monitoring. A classification into the following four groups is recommended: normal, warning, severe functional hemodynamic disorders (SFHD) and hypoxia. This fetal heart frequency (FHF) classification prefers the evaluation of the effects on fetal condition compared with a descriptive classification. SFHD in the first stage of labor can be observed in 4% of parturient women, increasing to nearly 16% in the second stage. Cesarean section rate in this group amounts to 12.5% and forceps rate exceeds 50%. Under the condition of elective fetal monitoring (94% in total) and a reserved application of cesarean section (4.3% in total) and generous forceps delivery (15% in total) a perinatal mortality rate of 13% for obstetrical material with high-risk concentration is achieved. The total acidosis rate (pH less than 7.20) decreases to 2.3%, whereas the rate of severe acidosis (pH less than 7.10) was observed in only 0.4% of the cases. With elective fetal monitoring a low cesarean section rate taking critical evaluation into consideration and using all conservative methods of treatment is obtained. By means of the generous application of the single or repeated bolus injection of 25 micrograms fenoterol and the operative shortening of the second stage of labor in the case of SFHD, the neonatal morbidity can be kept at a low level. The small number of fetal or maternal complications using the direct methods of fetal supervision and the careful operative termination of labor justifies the recommended obstetrical management.

Cesarean Section↗
PubMed1983

Thrombosis of the right umbilical artery, presumably related to the shortness of the umbilical cord: an unusual cause of fetal distress.

This case report concerns a late pregnancy complication, clinically apparent as severe variable decelerations in the first stage of labor. Emergency cesarean section delivered a mildly asphyxiated full-term newborn infant. Examination of the umbilical cord revealed a thrombus of the right umbilical artery, near the fetal side, confirmed by histological examination. The total length of the umbilical cord, only 30 cm, was below the limit necessary for uncomplicated delivery of the fetus near term. Transient stretching during fetal descent is thought to be responsible for constriction of the umbilical arteries, blood flow sludging and thrombosis. Although only a few cases have been reported, thrombosis of the umbilical vessels has to be considered whenever the fetal heart rate pattern shows unexplained variable decelerations.

Adult↗
PubMed1995

The correlation between transperineal sonography and digital examination in the evaluation of the third-trimester cervix.

OBJECTIVE: To determine the correlation between transperineal or translabial ultrasound and digital examination of the cervix in the third trimester in women presenting to the obstetrical triage area complaining of uterine contractions and/or rupture of membranes. METHOD: One hundred women were evaluated initially with an ultrasound unit using a 5-MHz glove-covered curvilinear transducer applied to the perineum in the sagittal plane. Immediately after the ultrasound evaluation, another examiner assessed the cervix digitally, blinded to the sonographic results. Cervical dilatation, length, and station were assessed. RESULTS: Transperineal ultrasound correlated (P < .001) with digital cervical examination in the assessment of dilatation (Pearson correlation coefficient 0.87), length (Pearson correlation coefficient 0.80), and corrected station (Pearson correlation coefficient 0.69). CONCLUSION: There is a statistically significant correlation between the digital cervical examination and the sonographic assessment of cervical dilatation, length, and station by the transperineal approach.

Adult↗
PubMed1989

Cardiotocography in cows: A method for monitoring calves during delivery.

Fetal ECG-electrodes and an intrauterine catheter were inserted into 15 Holstein-Friesian cows during their first stage of labor to make a cardiotocogram. Simultaneously, fetal heart rate and intrauterine pressure were recorded until completion of fetal expulsion. Immediatly post partum the viability of the calf was assessed by clinical evaluation and measurements of blood pH, base excess (BE) and pCO(2). Fetal heart rate patterns and their changes were evaluated according to standards used in human medicine. Basal fetal heart rate (90 to 120) in 10 calves gradually increased towards the end of parturition, with a marked loss of variability. Decelerations, coinciding with periods of increased intrauterine pressure, occurred in all cows. When decelerations occurred beyond the end of a contraction the calf was born in a poor condition. Accelerations were only recorded in two cows. Many of the fetal heart rate changes observed were similar to those which in human cardiotocography are considered to be signs of fetal distress. Further investigation is needed to establish the predictive value of fetal heart rate patterns in cows, which would be a welcome addition to improved fetal diagnostics during parturition.

Journal Article↗
PubMed2004

Complications of cesarean deliveries: rates and risk factors.

OBJECTIVE: The purpose of this study was to determine complication rates after cesarean delivery and to identify independent risk factors for complications. STUDY DESIGN: In a prospective population-based cohort study in Norway, rates of predefined types of complications from 2751 cesarean deliveries were determined. The complications that were studied were intraoperative complications, blood loss, wound infection, cystitis, endometritis, hematoma, and reoperation. Independent risk factors were identified by stratification and multiple logistic regression analysis. RESULTS: Altogether, 21.4% of the women had > or =1 complications. The degree of cervical dilation, general anesthesia, low gestational age, and fetal macrosomia were independent risk factors. For operations that were performed at 9 to 10 cm cervical dilation, the complication rate was 32.6% versus 16.8% at 0 cm (odds ratio, 2.39; 95% CI, 1.77-3.22; P<.001). CONCLUSION: Cesarean delivery was associated with a high complication rate. Increasing cervical dilation and, in particular, cervical dilation of 9 or 10 cm at the time of operation, general anesthesia, low gestational age, and fetal macrosomia were identified as independent risk factors.

Adolescent↗
PubMed2004

The effect of early epidural versus early intravenous analgesia use on labor progression: a natural experiment.

OBJECTIVE: The purpose of this study was to compare the effect of early epidural with the use of early intravenous analgesia on labor progression. STUDY DESIGN: We systematically selected singleton, nulliparous term pregnancies with a spontaneous labor and analgesia placement <or=4 cm who were delivered at a hospital where the rate of epidural analgesia in labor increased from 1% (before) to 84% (after) in 1 year (a natural experiment). In the before period (n=223 pregnancies), 98% of women used intravenous analgesia, and 2% of women used epidural analgesia. In the after period (n=278 pregnancies), 92% of women used epidural analgesia, and 8% of women used intravenous analgesia. The median duration of labor by each centimeter of cervical dilation was computed and used as a measurement of labor progression. RESULTS: After adjustment had been made for confounders, women in the after period had a slower labor progression only from 4 to 5 cm, compared with those women in the before period. Interestingly, the process of labor admission and epidural analgesia placement, rather than analgesia use per se, appeared to explain most of the slowdown. No significant difference in the rest of the active phase was observed between the 2 groups. CONCLUSION: Our data support recent American College of Obstetricians and Gynecologists guidelines that the restraining use of epidural analgesia at <4 cm of cervical dilation is unnecessary.

Adult↗