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PubMed1985

Cardiopulmonary arrest after the administration of magnesium sulphate. A case report.

The death of a patient from cardiopulmonary arrest after the administration of magnesium sulphate for imminent eclampsia is reported. It has long been recognized that magnesium sulphate provides rapid control of convulsions in eclamptic patients with minimal sedative effects on both mother and fetus. However, because of the neuromuscular blocking action of magnesium and the narrow margin between therapeutic and toxic serum levels, the drug must be given with caution. A regimen for magnesium sulphate administration is advocated which allows safe and effective control of convulsions in eclampsia.

Eclampsia↗
PubMed1979

[Plasmacortisol and parturition under epidural anaesthesia (author's transl)].

Plasma cortisol was determined by a radioimmuno assay during labour, at and after delivery in 16 primigravidas und epidural anaesthesia and was compared with 13 primigravidas, who delivered under pentazocine or pethidine and pudendal block. Cortisol levels decreased after effective epidural anaesthesia during the first stage of labor and for delivery. They increased in the control patients for delivery and was significantly higher than in the patients under epidural anaesthesia. Two and 20 hours post partum cortisol concentrations decreased in both groups. Cortisol levels in the fetuses and newborns was markedly lower than those of mothers. At delivery, the cortisol concentration of the newborns of both groups was the same. The changes of cortisol concentrations in this study support the conclusion that epidural anaesthesia during labor and delivery reduces stress for the mother, but not for the fetus.

Anesthesia, Epidural↗
PubMed1966

Paracervical block in obstetrics and gynecology.

Paracervical block anesthesia in the practice of obstetrics and gynecology is being used more and more often. It is accepted as a simple, safe and effective method. The author and his associates have used it in their private practice in more than three thousand patients. In almost all cases it completely relieves the pain of the first stage of labor, although additional anesthesia must be given for delivery. It is ideal for dilatation and curettage in poor risk patients and in patients with an incomplete abortion.

Anesthesia, Conduction↗
PubMed1981

[Proof of beta-2-adrenergic activity of etilefrin (effortil) via aimed recording of its tocolytic action (author's transl)].

In 21 normal deliveries the intrauterine pressure was measured continuously during the first stage of labor. Thus the tocolytic efficiency of Etilefrin was revealed. Intensity and duration of the tocolytic effect were related to the dose. Pressure and frequency of the contractions were diminished. Therefore these results are conclusive that Etilefrin, generally given for its alpha- and beta 1 mimetic effects, has an additional beta 2-mimetic and tocolytic component.

Adrenergic beta-Agonists↗
PubMed1983

[Formation of respiratory system function in ontogeny. I. Intrauterine respiratory movements].

The fetus rhythmic respiratory movements originate long before the birth at a certain stage of its intrauterine development, i. e. the rhythmic respiratory activity is formed before the delivery. As the fetation takes place the character of respiratory system rhythmic activity shifts to stabilization of respiratory muscles rhythmic action towards the termination of gestation. The fetal respiratory movements are inhibited with the beginning of the generic act.

Animals↗
PubMed1978

[Parturition under peridural anesthesia (author's transl)].

Basing on a study of 205 "matched pairs", it is shown to what extent peridural anesthesia (PA) influences the course of parturition, the type of termination of birth, and the intrapartal and post-partal condition of the child. The method of PA application is accurately described in the section "Material and Methods". The first stage of labor, or period of dilatation (PD) is not in any way effected by PA. However, PA will almost double the expulsion period (EP). Hence, elective termination of birth via technically simple, complication-free outlet forceps is usually propagated and employed significantly more often. Emergency sections or delivery by forceps due to mandatory indication, are not more frequent under PA than otherwise. The intrapartal condition of the child, measured with the cardiotocogram employing in the score according to Hammacher et al. (6) before and after application of PA, as well as during the last 30 minutes of birth (final score), is influenced only irrelevantly. The Apgar scores one minute and five minutes post partum, as well as the arterial umbilical cord pH values, do not differ significantly between the peridural and the control groups. The authors agree with the widespread opinion that, at the present moment, PA is the best obstetric analgesic method with simultaneous maximum possible safety for the fetus.

Anesthesia, Epidural↗
PubMed1984

The fetal heart rate W-sign.

A biphasic fetal heart rate variable deceleration pattern (W-sign) was investigated and found to be significantly associated with a greater length of umbilical cord (73.07 +/- 17.1 cm) than was found in patients without this pattern (56.47 +/- 11.4 cm) during the first stage of labor (P less than .001). The possible etiology of this variable deceleration pattern and its relative benignity are discussed.

Bradycardia↗
PubMed1983

Prolapse of the cord: reduction of perinatal mortality by bladder instillation and cesarean section.

The fetal outcome in 135 cases of cord prolapse seen during the period 1970-79 was studied. The fetus was alive at diagnosis in 127 cases. In 88 (69.3%) of the cases, the cord prolapsed during the first stage of labor and they were managed by Vago's method of rapid instillation of saline into the bladder to relieve cord pressure during preparation for cesarean section (CS). In the remaining 39 cases, the cord prolapsed during the second stage of labor and the patients were delivered vaginally. The overall perinatal mortality rate was 8.1%. The perinatal mortality rate among cases with a live fetus at diagnosis was 2.4%. In spite of a long diagnosis-delivery interval, no fetal deaths occurred in the 88 cases managed by bladder instillation and CS. Vaginal delivery of footling presentations was associated with a fetal mortality of 18.2%. The infant depression rate was significantly higher in breech vaginal deliveries than in CSs (P less than 0.001). Fetal bradycardia at the time of diagnosis was associated with an increased infant depression rate following vaginal delivery (39%) as compared with CS (10%). The CS rate in this series is the highest and the perinatal mortality among the lowest yet reported.

Cesarean Section↗
PubMed1980

Face presentation at term.

A retrospective study was conducted of 50,300 consecutive deliveries between July of 1973 and January of 1978. There were 40 instances of face presentation with gestational age greater than 36 weeks and fetal weight greater than 2500 g for an incidence of 1 per 1250 deliveries. Cesarean section was performed in 50% of cases. Spontaneous vaginal delivery occurred with mentum anterior presentation 88% of the time, with mentum transverse presentation 45% of the time, and with mentum posterior presentation 25% of the time. Fetal heart rate (FHR) monitoring was available for review in 29 of the 38 (76%) live births. Internal techniques were used in 79% and external techniques in 21% of the cases. The FHR patterns were classified according to the predominant pattern seen in the first stage of labor. In 59% (17 of 29), variable decelerations were noted, and severe variable decelerations were present in 29% (8 of 29). Late decelerations were noted in 24% (7 of 29) of cases. Only 4 patients completed labor without variable or late decelerations. There were 38 live births and 2 stillbirths. Both of the stillborns were noted to have tight nuchal cords which were believed to be the cause of death. One death occurred intrapartum. Of the 38 live births, there were 14 (37%) with 1-minute Apgar scores of 6 or less and 5 (13%) with 5-minute Apgar scores less than 7. Four of the 5 low 5-minute Apgar scores occurred in babies with mentum posterior position. Of the 23 patients monitored by internal electrodes, no serious trauma was noted as a result of the electrode placement.

Adult↗
PubMed1980

Correlation of meconium-stained amniotic fluid, early intrapartum fetal pH, and Apgar scores as predictors of perinatal outcome.

A prospective study was undertaken to determine if the passage of meconium during the early intrapartum period (cervical dilatation 3 cm or less), the type of meconium passed (thick versus thin), and fetal pH values could be correlated with Apgar scores as a predictor of neonatal outcome. One hundred seventy-seven patients had meconium-stained amniotic fluid and a cervical dilatation of 3 cm or less at admission. Group 2 (thick meconium) had significantly lower 1- and 5-minute Apgar scores, lower scalp pH values, and increased risk factors, such as prolonged pregnancy, small-for-gestational-age fetus, and fetal heart rate abnormalities. Group 2 (thin meconium) and the control group (nonmeconium) appeared to have no increased associated risks. Thick meconium as a single variable appeared to be the most significant factor influencing fetal outcome; however, if an associated fetal heart rate abnormality was present, perinatal morbidity was greatly increased as indicated by fetal acidosis and lower 1- and 5-minute Apgar scores. It thus appears that early passage of thick meconium does correlate with fetal outcome and increased perinatal morbidity. The significance of meconium passage is discussed and a modern obstetric management scheme for these high-risk patients is presented.

Acidosis↗
PubMed1993

Fetal acoustic stimulation for rapid intrapartum assessment of fetal well-being.

Fetal heart rate reactions to the fetal acoustic stimulation test (FAST) were prospectively studied in 140 women in early labor. Overall 45 of 140 patients (32%) had one or more complications of pregnancy. All were in the latent phase of labor with a singleton, vertex-presenting fetus. Gestational age ranged from 37-43 wks. The women were screened with a 15-20 min fetal heart rate recording (FHR admission test) before the acoustic stimulation was applied. Results of the FHR admission test and the FAST in women were compared with fetal outcome; which was considered poor when there was perinatal death, a 5 min Apgar score less than 7, fetal distress requiring cesarean section, thick meconium stained amniotic fluid or admission to the neonatal intensive care unit. FAST had better sensitivity (71.4% vs 42.8%), specificity (99.2% vs 97.7%), positive predictive value (83.3% vs 50.0%) and negative predictive value (98.5% vs 97.0%) for poor fetal outcome than the FHR admission test. Fetal acoustic stimulation test in the early intrapartum period may be used as a noninvasive screening method for rapid intrapartum assessment of fetal wellbeing. It may discriminate the compromised from the noncompromised fetus. This clinical application can be helpful in a busy labor room when rapid assessment of fetal health is required.

Acoustic Stimulation↗
PubMed1994

Prophylactic amnioinfusion for oligohydramnios: a reevaluation.

OBJECTIVE: To compare the effects of prophylactic amnioinfusion to standard care plus indicated therapeutic amnioinfusion (for variable decelerations) in term patients with oligohydramnios. METHODS: One hundred sixteen term gestations with oligohydramnios (amniotic fluid index less than 5.0 cm) were randomly assigned to receive prophylactic saline amnioinfusion (600-mL bolus followed by 3 mL/minute) or standard obstetric care (control). Control patients who subsequently developed moderate or severe variable decelerations received therapeutic amnioinfusion. RESULTS: There was no significant difference in overall cesarean delivery (21 versus 17%; P = .68), cesarean delivery for fetal distress (7 versus 10%; P = .83), or umbilical gas values between the prophylactic amnioinfusion group (N = 56) and control group (N = 60), respectively. The rate of intrapartum fever was significantly increased among the prophylactic amnioinfusion patients (23 versus 7%; P = .02), although the duration of intrauterine monitoring (8.8 versus 6.5 hours; P = .06) and time from ruptured membranes to delivery (12.3 versus 14.3 hours; P = .51) were not different. Only 22% of the controls developed moderate or severe variable decelerations in the first stage of labor and received therapeutic amnioinfusion. Thus, in approximately four of five term patients with oligohydramnios, neither prophylactic nor therapeutic amnioinfusion would be indicated. CONCLUSIONS: Compared to indicated amnioinfusion, prophylactic amnioinfusion did not improve perinatal outcome. Amnioinfusion should be reserved for term laboring patients with variable fetal heart rate decelerations, rather than all patients with oligohydramnios.

Adult↗