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PubMed2003

Intrapartum management of multifetal pregnancies.

Over the past several decades advances in assisted-reproductive technologies have resulted in a dramatic increase in the number of multifetal gestations. Concomitant with this increase there has been a gradual rise in the overall preterm birth rate, as well as other pregnancy complications related to these pregnancies. Twin, triplet, and other high-order multifetal gestation pregnancies pose a number of important issues related to antepartum and intrapartum management. Antepartum issues include ultrasound determination of zygosity, management and prevention of preterm labor, maternal/fetal surveillance for complications, and specific interventions focused on prevention of adverse maternal and/or fetal outcomes. Intrapartum issues include those related to timing of delivery, labor management, anesthesia options, and determination of an optimal delivery modality. Clearly, these issues related to the management of multifetal pregnancies are of paramount importance to optimize pregnancy outcome. As many of the issues related to antepartum care for women with multifetal gestations have been reviewed elsewhere, we have restricted the focus of this article to intrapartum management. Thus, this article reviews salient issues related to the intrapartum management of multifetal gestations, including twins, triplets, and other high-order pregnancies.

Anesthesia, Obstetrical↗
PubMed1995

Obstructed labor and shoulder dystocia.

Dystocia of labor has become one of the leading indications for operative delivery during the past few years. Dystocia of the first stage of labor complicates 8-11% of all vertex delivery, and in the second stage of delivery it is at least as common. Dystocia may result in part from three factors: uterine activity, the fetus, and the pelvis. In each case of abnormal labor, assessment should be made according to those criteria. Shoulder dystocia is an infrequent, unanticipated, and unpredictable nightmare for the obstetrician. Although it is difficult to predict shoulder dystocia, effort should be made to prevent it. Tight glucose control in the management of diabetic patients will reduce the incidence of macrosomic fetuses. Cesarean section should be considered for diabetic women carrying fetuses with estimated fetal weight of greater than 4250g and for non-diabetic women carrying fetuses with estimated fetal weight of greater than 4500g. In all cases good clinical judgement can reduce the rate of shoulder dystocia. However, in some cases it remains a problem for the obstetrician and because it occurs so rarely, the care provider may have limited skills to manage this condition.

Dystocia↗
PubMed1986

Precocious cervical ripening and preterm labor.

A group of 8303 women was studied to determine the timing of cervical ripening. It was confirmed that these signs of cervical change can be observed several weeks before preterm births. The precocious signs of external ripening can be recognized during a vaginal examination and may be useful in predicting preterm labor.

Cervix Uteri↗
PubMed2001

Obstetric vacuum extraction: state of the art in the new millennium.

This article summarizes the current state of knowledge of obstetric vacuum extraction. The discussed topics include the history of vacuum extraction, indications and contraindications, technique of the procedure, currently marketed instruments, special uses of the vacuum extractor, comparison of vacuum extraction with forceps delivery, and maternal and fetal outcomes. Areas of controversy are identified and discussed. Vacuum extraction is replacing forceps as the preferred method of instrumental delivery.

Adolescent↗