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At least 1,117 records · Page 62Linked to original sources
PubMed1998

[Increased birth weights in the Nordic countries. A growing proportion of neonates weigh more than four kilos].

The proportion of children with high birthweights is increasing in Sweden, as in the other Nordic countries. According to the Swedish national birth registry (founded in 1973), the proportion of term (i.e. (37 gestational weeks) offspring of singelton pregnancies, and weighing four kg or more, increased from 16.9 per cent in 1973 to 20.3 per cent in 1995. The respective figures for the first-born subgroup were 12.9 and 15 per cent, the increase in mean birthweight being from 3400 to 3520 g. There was a corresponding increase in head circumference. The risk of delivery-related complications increases with birthweight over four kg, and a higher incidence of major perineal rupture (grade 3 or 4) has been reported, as well as a disturbing increase in the incidence of brachial plexus damage. Findings in recent studies suggest high birthweight to be associated with an increased risk of subsequent morbidity, both in childhood and in adulthood, specifically diabetes type 1, eczema and certain malignancies, particularly breast cancer and prostate cancer. Although the cause of the increasing proportion of large newborns is not known, it may be partly due to weight increase among gravidae. Another possible explanation is reduced maternal smoking, as smoking is less common now than in the 1970s.

Birth Weight↗
PubMed2006

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal delivery.

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice.

Adult↗
PubMed1994

Hospital stay due to various hysterectomies, caesarean section and normal delivery in Turku University Central Hospital area from 1983 to 1992.

The optimal length of hospital stay in obstetrics and gynaecology has recently been much debated, as short hospitalisation times being commonly introduced as alternatives to conventional hospitalisations. The hospital stay for major gynaecological and obstetric surgery as well as normal delivery was studied in the hospitals working in area of the Turku University Central Hospital (population approximately 750,000). In the six studied hospitals the mean hospital stay for abdominal and vaginal hysterectomy decreased during the 1980s by one fifth. In 1992, the mean hospitalisation for hysterectomy varied from 7.4 to 8.3 and from 9.0 to 9.1 days, for abdominal and vaginal hysterectomy, respectively, and that of caesarean section from 8.1 to 8.6 days. The number of days in hospital required for normal delivery was 4.4-6.2 days. These figures are similar to the corresponding national average in Finland, but they also show that the discharge in our country occurs some 2 to 3 times later than what has recently been reported, e.g. from the U.S.A. Consequently, we find that there is a need for a prospective trial to find out how rational short hospitalisation is in the field of obstetrics and gynaecology in Finland.

Adult↗
PubMed2001

Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women.

OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.

Adult↗
PubMed2001

Morbidity of first trimester aspiration termination and the seniority of the surgeon.

Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The following outcomes were measured: surgical curettage for presumed retained products of conception; continuing pregnancy; uterine perforation; pelvic sepsis requiring intravenous antibiotics; and blood transfusion required. The complete abortion rate was 94.6% and the rate of continuing pregnancy 0.24%. There was a significant relationship between efficacy and seniority of the surgeon; consultants, senior registrars, registrars, and senior house officers had complete abortion rates of 97.8, 92.8, 94.7, and 88.4% respectively (P = 0.039). Parity did not affect efficacy. Terminations at 12-13 weeks gestation were associated with a significantly lower complete abortion rate. The rates of uterine perforation, blood transfusion, pelvic sepsis requiring intravenous antibiotics, and overnight hospital admission were 0.24, 0, 0.97, and 1.69% respectively. Thus, the only significant factors affecting outcome of surgical abortion are grade of operating surgeon or terminations performed at later gestations of 12-13 weeks. It is vital that physicians performing surgical terminations are adequately trained.

Abortion, Induced↗
PubMed2004

Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial.

OBJECTIVE: To estimate the effectiveness of paracervical block in controlling pain among women treated with manual vacuum aspiration for an incomplete abortion METHODS: A randomized clinical trial was conducted at Nuestra Señora de Altagracia, a maternal and perinatal referral hospital in the Dominican Republic. The sample size was based on a clinical difference of 1.5 points in the level of pain measured with the visual analog scale using 90% power and a sampling error of 0.04. Women who were at 12 weeks of gestation or less with an incomplete abortion were eligible to participate. They were randomly assigned to receive either the standard treatment of care (manual vacuum aspiration for uterine evacuation with psychological support but no paracervical block) or manual vacuum aspiration treatment with psychological support and paracervical block using 1.0% lidocaine. Patients with active infections, severe illnesses, psychiatric disorders, or allergies to lidocaine were excluded. Intraoperative pain as reported by the women and as documented by an external observer was measured. RESULTS: Although the paracervical block technique used showed a slight reduction in severe pain, there were no clinically or statistically significant differences in intraoperative pain between the 2 groups (relative risk 0.73; 95% confidence interval 0.43, 1.23) with 50% of all patients registering 7 or higher score on a visual analog pain scale of 0-10. However, statistically significant differences were found in each group when comparing the level of preoperative and intraoperative pain described by the patient (P <.001). The manual vacuum aspiration technique and the paracervical block were not accompanied by complications. CONCLUSION: The paracervical block technique used in this study along with psychological support was comparable with pain control using psychological support alone; neither pain management regimen provided sufficient pain control. It is recommended that randomized comparative studies be designed to determine the effectiveness of other paracervical block techniques and the efficacy of the use of analgesics in patients suffering from incomplete abortion treated with manual vacuum aspiration.

Abortion, Incomplete↗
PubMed2006

Outcomes of pregnancy beyond 37 weeks of gestation.

OBJECTIVE: The aim of the study was to evaluate pregnancy outcomes by weeks of gestation. A second aim was to assess the outcomes in groups with spontaneous or induced labor. METHODS: This was a prospective cohort study of singleton pregnancies delivered after 37 weeks of pregnancy covering a well defined region in Norway from 1990 to 2001 (N = 27,514). Linear regression, chi 2 tests, and multivariable logistic regression analysis were used. RESULTS: Maternal complications varied with gestational age, and were lowest at 39 weeks and highest postterm (cesarean delivery 12.3-21.6%, operative vaginal delivery 10.7-15.4%, maternal hemorrhage 9.7-14.6%). Poor neonatal outcome varied with gestational age only for spontaneous labors (Apgar at 5 minutes less than 7 1.0-2.3%, pH less than 7.10 3.4-5.2%), whereas induction of labor was a risk factor for delivery complications (odds ratio 1.3-2.8), independent of gestational weeks. CONCLUSION: Poor pregnancy outcomes vary with gestational age. Postterm pregnancy and induced labor are prognostic factors for poor outcome.

Adult↗
PubMed2006

Vacuum-assisted delivery: an analysis of traction force and maternal and neonatal outcomes.

Safety recommendations for vacuum-assisted delivery focus on limiting the number of pulls and the duration of the procedure. With the introduction of the Kiwi OmniCup vacuum extractor incorporating a Traction Force Indicator, it is now possible to reliably monitor and control the amount of traction force exerted on the fetal scalp. The OmniCup was used in a prospective observational study of 119 vacuum-assisted deliveries in nulliparous women to establish practical guidelines for safe practice in typical clinical settings.

Adult↗
PubMed2004

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review.

OBJECTIVE: To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. DATA SOURCES: Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. STUDY SELECTION: Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. DATA SYNTHESIS: Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). CONCLUSIONS: Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.

Analgesia, Epidural↗
PubMed1998

Reported comfort with obstetrical emergencies before and after participation in the advanced life support in obstetrics course.

BACKGROUND AND OBJECTIVES: Prior research has demonstrated a change in Advanced Life Support in Obstetrics (ALSO) course attendees' reported comfort with managing specific obstetrical emergencies and procedures before and immediately after participation in an ALSO course. Assessment of longer-term stability of these changes has not been performed. This study measured changes in comfort with obstetrical emergencies and reported practice patterns 1 year after ALSO training. METHODS: ALSO course attendees (275) were given a grounded Likert scale survey measuring reported comfort with the management of specific obstetrical emergencies and procedures before, immediately after, 6 months after, and 1 year after participation in an ALSO course. Practice patterns were also surveyed. Paired data were analyzed using the Kruskal-Wallis one-way ANOVA test at a 95% confidence interval for two-tailed significance. RESULTS: ALSO course participants reported a significant increase in their comfort with the management of each of 15 obstetrical emergencies and procedures taught in the ALSO curriculum. Reported comfort remained high at 6 months' and 1-year follow-up and was accompanied by a statistically significant change in reported practice patterns; more participants performed, in their practice 1 year after completion of ALSO training, amnioinfusion, vacuum-assisted vaginal delivery, and ultrasound for determining fetal position and placental location. CONCLUSIONS: Affective learning is important in translating knowledge and skills into the practice of medicine. Our study demonstrates that participation in the ALSO course increases participants' knowledge in the affective domain of learning.

Amnion↗
PubMed1995

An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers.

OBJECTIVE: To generate an objective definition of shoulder dystocia by timing the events of the second and third stages of labor, and to define the true incidence of shoulder dystocia. METHODS: In 34 arbitrarily selected 24-hour time periods, a nonparticipating observer prospectively timed intervals of the second stage of labor in all vaginal deliveries and recorded the use of obstetric maneuvers (McRoberts, episiotomy after delivery of the fetal head, intentional extension of initial episiotomy after delivery of the fetal head, suprapubic pressure, posterior arm rotation to an oblique angle, rotation of the infant by 180 degrees, delivery of the posterior arm, and general anesthesia) and whether the obstetric attendant identified a delivery with shoulder dystocia. All data are reported as mean +/- standard error of the mean. RESULTS: Two hundred fifty deliveries were timed and recorded prospectively. Mean intervals (in seconds) in nonmaneuver patients were as follows: head to anterior shoulder 14.8 +/- 1.0, anterior to posterior shoulder 3.9 +/- 0.6, posterior shoulder to body 5.4 +/- 0.8, and total head-to-body time 24.2 +/- 1.3. Three groups of patients were defined after delivery. The maneuver group consisted of 27 patients requiring any of the aforementioned obstetric maneuvers, although the obstetric attendant identified only 16 of these as shoulder dystocia. The prolonged delivery group included 29 patients with the head-to-body delivery interval exceeding the mean plus two standard deviations (60 seconds) of nonmaneuver patients. Sixteen of the 27 maneuver patients were identified as prolonged. The 210 not identified as maneuver or prolonged were considered to be normal. Normal patients had a significantly lower newborn birth weight (3269 +/- 38 g), and a lower proportion of 1-minute Apgar scores of 7 or less (11%) than did the maneuver (4247 +/- 86 g, 41%) and prolonged groups (3952 +/- 118 g, 34%). Defining shoulder dystocia as a prolonged head-to-body delivery time and/or the use of obstetric maneuvers identified 40 patients who had birth weights and 1-minute Apgar scores significantly different from the normal patients. CONCLUSION: The incidence of shoulder dystocia, as defined by the use of ancillary obstetric maneuvers, is higher than that reported previously, and the reporting of shoulder dystocia appears to be unreliable. The interval from head-to-body delivery is delayed significantly in patients with shoulder dystocia, despite the lack of recognition of shoulder dystocia. We propose defining shoulder dystocia as a prolonged head-to-body delivery time (eg, more than 60 seconds) or the need for ancillary obstetric maneuvers.

Adult↗