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PubMed1996

[Deliveries at a department of surgery during a 10-year period].

In order to see whether the pattern of referral of pregnant women, intervention during labour and transport of neonates had changed over a 10-year period, we investigated these variables in the women who gave birth at our department of surgery in 1978, 1981 and 1988. The numbers of women were 790, 630 and 697 respectively for the three years, and the corresponding numbers of neonates transferred to the neonatal unit were 56, 44 and 53 respectively. The frequencies of risk pregnancies increased from 20% in 1978 to 37.7% in 1999, (p < 10(-6) and the frequency of primiparity increased from 43% to 51.2% over the same period (p < 10(-5)). More women underwent elective caesarean section due to an increased number of breech presentation in nulliparous women (p < 10(-3)). The frequency of induction of labour decreased from 21.7% to 16.5% (p < 10(-6)). The perinatal mortality ranges between 0% to 0.48% during the 10 years, and the rates of transfer of neonates to the neonatal unit were unchanged (7.1-7.6%). It is concluded that changes in referral and composition of the population had no influence on the incidence of acute intervention in labour or rate of neonatal transfer.

Adult↗
PubMedDate not supplied

Tropical obstetrics and gynaecology. 3. Vesico-vaginal fistula--a tropical disease.

The predominantly obstetric origin of vesico-vaginal fistulae in the tropics is contrasted with the mainly surgical aetiology of those in Europe by analysis of 543 cases treated in Nigeria and in the United Kingdom. Reasons are given for the high incidence in tropical countries of obstructed labour and hence of vesico-vaginal fistulae. The general management of patients with obstetric fistulae is described, followed by the principles of their surgical treatment and postoperative nursing care. The importance of success at the first attempt at repair is stressed, and the small place for managing failures by urinary diversion is mentioned. It is concluded that obstetric fistulae should be preventable in the tropics, having now been effectively eliminated from industrialized countries.

Cesarean Section↗
PubMed1996

[When children "have children"--reproduction biological problems in girls between 11 and 15 years of age].

The aim of the present study was to evaluate the obstetric risk in pregnant adolescents under 16 years of age. From July 1, 1970 to June 30, 1993, 188 girls aged 11-15 years were delivered at the 2nd Department of Obstetrics and Gynaecology, Vienna; 4569 primiparous women between 20 and 24 years with singleton pregnancies served as a control group. No significant differences between the two groups were found for the frequency of pregnancy-induced hypertension (2.1% vs. 3.5%), premature delivery rates (24.4% vs. 29.8%), percentage of babies weighing less than 2500 g (10.1% vs. 9.1%), mean birthweight (3082 g vs. 3117 g), frequency of intrauterine growth retardation (2.1% vs. 2.4%) and malformations (1.6% vs. 3.1%) and perinatal mortality to the end of the first week (1.1% vs. 0.5%). Adolescent mothers were found to have more spontaneous deliveries (85.1% vs. 74.9% in the control group, p < 0.005), lower Caesarean section rates (6.4% vs. 11.3%, p < 0.05) and fewer babies with a birthweight exceeding 4000 g (1.1% vs. 4.3%, p < 0.05). For the first time, the pregnancy outcome of European adolescents was studied over a period of 23 years. We conclude on the basis of our results that maternal and neonatal risk in mothers under 16 years of age does not exceed the obstetric risk in adult mothers.

Adolescent↗
PubMed1999

Have Kielland forceps reached their 'use by' date?

Kielland forceps have long been used in Australian hospitals for rotation and delivery from occipitolateral and occipitoposterior positions. We have studied the pattern and use of these forceps in our hospital, and conducted a statewide survey of obstetric trainees about their experience with Kielland forceps. We conclude that current obstetric training programmes are unlikely to provide registrars with sufficient skill in their safe use.

Clinical Competence↗
PubMed1992

[The inventors of the obstetric forceps and the obstetric lever].

A multiple lineage is proposed for the invention of the obstetric forceps. Having been conceived by a member of the Chamberlen family in fifteenth- or seventeenth-century England, the instrument seems to have been reinvented in Flanders by Jan Palfyn and in Holland by Rogier Roonhuyse. Later, Roonhuyse invented a more effective instrument for coping with the impacted head: the obstetric lever. Palfyn's "Iron Hands" inspired Dussé to produce the "French" forceps which bears his name.

Belgium↗
PubMed2001

The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes.

OBJECTIVE: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery. STUDY DESIGN: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries. RESULTS: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations. CONCLUSION: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.

Adult↗
PubMed1997

Management and outcomes of posterior fossa subdural hematomas in neonates.

OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. METHODS: A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning. RESULTS: There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean 5-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth. CONCLUSION: PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.

Birth Injuries↗
PubMed1975

A double-blind trial of bupivacaine and etidocaine in epidural block for surgical induction of labour.

Compared to bupivacaine, etidocaine has a quicker onset of action both in terms of initial analgesia and time taken to reach maximal extent of analgesia. ;owever, its duration of action is significantly shorter and it produces a striking degree of motor loss. These last two properties make etidocaine relatively unsuitable for obstetric practice, where a long duration of action and a reasonable mobility are desirable. However, it has been found useful for forceps delivery, because of the good muscle relaxation obtained and, because of its greater penetration, in abolishing the missed segments sometimes seen with bupivacaine.

Acetanilides↗
PubMed2001

[Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome].

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.

Adult↗
PubMedDate not supplied

[Significance of the site of uterine contraction for labor progress and duration of pregnancy].

A four-channel topographic technique was developed in order to improve information about spatial uterine motility. 54 women were monitored during delivery. Four pressure transducers were attached in a square around the umbilicus. Most frequently the origin of labour could be determined in the upper right segment of the uterus. The rate of operative deliveries was decreased in case of predominant upper right origin of labour. The majority of contractions with clear propagation patterns originated at the upper right site, continued to the left and then to the lower right part of the uterus. The highest relative intensity was also measured at the upper right site. Predominant upper right origin of labour may be important for undisturbed delivery. The probability of a preterm delivery is increased in case of an upper right origin of labour.

Adult↗
PubMed1999

For whom is the Caesarean section rate high?

AIM: To define a method for examining and comparing Caesarean section rates. METHODS: Data on Caesarean section rates at National Women's Hospital for 1997 were analysed by two methods which adjust Caesarean section rates according to casemix: 1. standard nulliparae and 2. grouping women by factors influencing Caesarean section rates. RESULTS: The Caesarean section rate in New Zealand is rising and National Women's Hospital had a Caesarean section rate of 22.3% in 1997. The instrumental vaginal delivery rate was 13.1%. Our 1997 data were analysed for casemix -- standard nulliparae and dividing women into six distinct groups. The Caesarean section rate for standard nulliparae was 19.2%. Nulliparae had an increased induction of labour rate compared to multiparae (29.1% versus 22.9%, p < 0.001). The Caesarean section rate was increased in association with induction of labour for nulipare (26.0% versus 13.1%, p < 0.001), multiparae with unscarred uteri, (5.4% versus 2.5%, p < 0.001) and primiparae with previous caesareans (36.8% versus 30.4%, p = 0.02) CONCLUSION: We suggest our second method of grouping women by the most important factors influencing intervention rates should be used by obstetric units for benchmarking and internal audit purposes.

Adult↗
PubMed2000

[Choice of delivery method in multiple pregnancy. I. Twins].

From 1995 till 1998 year 174 twin pregnancies were delivery at the SUH "Majchin Dome" in Sofia. The methods, applied for delivery was: per vies naturalis 78 (51, 32%) women (normal vaginal delivery 63 pregnancies, breech delivery--12, with vacuum extractor--2 and with forceps--1); by cesarean section was delivered 74 (48, 68%). The 80 pregnancies with premature delivery (under 37 g.w.) were delivered by: normal vaginal delivery--(55.13%) and cesean section--37 (50%). Indication for operative delivery were: irregular position--45, sterilitas primaria--13, EPH Gestosis--12, asphyxia intrpartum--9, previous cesarean section--3, luxatio coxe congentia--4, age over 31 years--4, abruptio placente--2, condilomata acuminata--2. We not find significant difference in experience on new-born depending on the method for delivery after 35 g.w. We find the best experience by new-born, delivered with cesarean section between 28-33 g.w. and 33-35 g.w. (50% and respectively 100%) compared to delivered per vies naturalis (43.75% and 86.36%). The authors consider the it is desirable liberation on indications for delivery with cesarean section by the twins between 28-35 g.w.

Breech Presentation↗
PubMed2002

[German-speaking midwifes prefer vaginal mode of delivery to elective Caesarean].

Increasing ceasarean section rates are a world wide concern in obstetrics. One of the latest contributing factors is the elective caesarean section in uncomplicated singleton pregnancy at term. The preference for this mode of delivery was primarily brought forward by obstetric practitioners (Al Mufty, McCarthy, Fisk 1996). A questionnaire, which mainly aimed to ask germanspeaking midwifes in Austria, Germany and Switzerland about their personal choice of delivery mode, was included in one of the issues of the German-language midwifery journal "Die Hebamme". This questionnaire contained 5 half-closed/half open questions describing specific obstetric occurrences. The midwifes were asked to express their preferred mode of delivery and describe their reason for choosing. 446 questionnaires (12 %) were returned. The majority (100 %) of the german speaking midwifes preferred a normal vaginal delivery in an uncomplicated singleton pregnancy at term with a child in cephalic presentation. The rating was about the same (97 %) in the presence of general risk factors which don't indicate a primary caesarean section. Breech presentation and macrosomia are a matter of concern to the midwifes. Midwifes arguing for a first child in breech presentation or with macrosomia > 4.5 kg vote highly significantly more frequently for elective caesarean section than midwifes arguing for at least the second child. The first-rate reasons for the preference of vaginal delivery concern the natural and physiological way of delivery, the personal experience of delivery, the higher risks of caesarean section and the possibility of a later caesarean section in case of fetal distress during first or second stage of labour. Concerns are expressed about the maintenance of competence amongst practitioners, thus influencing the choice of mode of delivery in obstetrics.

Attitude of Health Personnel↗
PubMed2002

Mode of delivery and risk of developing allergic disease.

The aim of this study was to quantify the relationship between mode of delivery and subsequent incidence of allergic disease. The analysis is based on data derived from a birth cohort of 24,690 children who contributed data to the West Midlands General Practice Research Database. We found no convincing evidence to suggest that babies born by caesarean, forceps, or breech delivery had an increased risk of developing allergic disease.

Asthma↗
PubMed1984

Serum cortisol levels of maternal vein, umbilical artery, and umbilical vein classified by mode of delivery.

We measured maternal venous (MV), umbilical arterial (UA), and umbilical venous (UV) cortisol levels of 180 pregnancies at term. The cortisol level of MV was higher than that of UA and UV in all deliveries. The cortisol levels of three samples had no difference between the induced labor group and the spontaneous onset of labor group regardless of delivery mode. In spontaneous vaginal delivery the cortisol levels of three individual samples were significantly higher in primipara than in multipara. The positive correlations were observed in any modes of deliveries between the cortisol levels of MV and UA, and MV and UA and UV. These data suggest that the fetus may produce cortisol by itself and maternal cortisol may inflow to the fetus.

Breech Presentation↗