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PubMed1981

[Experiences with single-shot peridural anaesthesia in obstetrics (author's transl)].

Analysed are the epidural anaesthesias of the years 1977 and 1978, which were carried out with the single-shot-method. Frequency of instrumental vaginal delivery of primiparae and multiparae, outcome of the newborn immediately post partum by the Apgar-score and complications compared with a group without epidural anaesthesia are being examined. There is an increase of instrumental vaginal deliveries from 5,7% to 21% after using epidural anaesthesia. Primiparae are mainly concerned by 29,2%, whereas multiparae are only concerned by 10%. The whole rate of complication is 14,4% (here of hypotension in 7,8% of the cases). Asphyxias of the newborn are not significantly more frequent in the group with epidural anaesthesia. For the time the epidural anaesthesia remains the most effective method of analgesia during the delivery, although the maternal and fetal risk should not be underestimated.

Anesthesia, Epidural↗
PubMedDate not supplied

[Obstetrical maneuvers: a personal technic of digital rotation].

After a brief discussion of the abuse of cesarean sections over the last ten years, the authors describes a personal obstetric manoeuvre used in posterior occipital presentations; namely in those positions in which dystocia may easily occur possible harmful consequences of both the patient and fetus. The aim of this manoeuvre is to encourage or accelerate the third stage of labour and consists in using the two exploratory fingers, the index and middle fingers, to press during contractions on the left fronto-parietal zone in the right posterior occipital position or 2nd position, and on the right frontoparietal zone in the left occipital position or 4th position. Pressure must be exerted in a clockwise direction, from right to left, in position 2 (OIDP) and in an anticlockwise direction, from left to right, in position 4 (OISP) to ensure that, in both cases the occiput rotates through 3/8 of a circle to come under the pubic symphysis. The author describes the advantages and good results obtained, and expresses the hope that these may soon be confirmed by major obstetric centres.

Apgar Score↗
PubMed1994

[Surgical delivery: comparison of two 5-year periods].

Operative delivery prevalence is considered in two periods: 1980-1985 and 1986-1990. Reduced prevalence of repeated cesarean section is reported for the second period as opposed to the first one. A larger prevalence of cesarean sections for anomalous presentation (breech presentation included), fetal distress. EPH gestosis, abruptio placentae is reported in the second half of '80's. Vacuum Extractor applications are reduced in the second period compared to the first one for with concern secondary uterine hypokinesia; larger V.E. applications are reported in the second period for fetal distress in the second stage of labor. Relatively rare forceps applications in both periods.

Breech Presentation↗
PubMed1989

[Indications for cesarean section in the delivery of the 2d twin after vaginal birth of the 1st twin].

Cesarean section for delivery of twin B after vaginal delivery of twin A is a rare and extraordinary event in obstetrics. From 1.1.82-31.12.86, from a total number of 9357 deliveries, 133 pairs of twins (1.4%) were born. In 3 cases (2.2%) twin B was delivered by cesarean section after vaginal delivery of twin A. Taking into account 51 published cases in the recent literature, the indications for cesarean delivery of the second twin were demonstrated and compared. In the main, emergency situations presenting more than one obstetrical complication were responsible for this uncommon practice. Regarding the results presented, cesarean section of the second twin after vaginal delivery of the first-born seems to be a proven procedure to deliver the second twin faster and more safely than by hazardous vaginal manipulations, especially in obstetrical emergency situations.

Apgar Score↗
PubMed2002

Operative delivery during labour: trends and predictive factors.

Monitoring operative delivery trends provides the opportunity to consider whether changes are in a direction that will achieve the best outcomes for mothers and their infants. The aims of this study were to identify trends in and predictors of operative delivery (forceps, vacuum or caesarean) among women who have labour; and to determine trends in the operative methods used. The study was based on 616 303 live, singleton, term births delivered between 1990 and 1997 in New South Wales, Australia. There was no change in the annual percentage of women who experienced labour and 20% had an operative birth during labour. The vacuum to forceps ratio declined from 1 : 6 in 1990 to 1 : 1 in 1997. Among women with labour, caesareans increased from 6.4% to 7.8%. For primiparae, the factors predictive of operative delivery (epidural analgesia, age > 34 years, induced or augmented labour and private care) did not change over time. A predictive model for multiparae did not have adequate fit, indicating the importance of data on prior birth history. Studies of trends in operative deliveries are most useful and consistent with decision making when interventions before the onset of labour and during labour are analysed separately. Furthermore, the vacuum:forceps ratio provides a useful tool for comparative analyses.

Adult↗
PubMed2001

Economic aspects of caesarean section and alternative modes of delivery.

Increases in caesarean section rates worldwide have raised questions about the economic implications of caesarean section and alternative modes of delivery. This chapter reviews economic aspects of caesarean section and alternative modes of delivery and identifies areas where further research is required. The chapter presents the results of a systematic review of the literature and analyses of three large observational data sets. It provides evidence for the cost of labour and delivery, the cost of the postnatal stay and the cost of the long-term health consequences of alternative modes of delivery. The chapter highlights the paucity of methodologically robust economic analyses in this area of health care and concludes that primary research is required to estimate the cost and utilization of services attributable to caesarean section and alternative modes of delivery. Future research studies should recognize the long-term health service costs and the costs that arise outside the health service, which are likely to vary according to mode of delivery.

Cesarean Section↗