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PubMed1993

Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma.

OBJECTIVE: A review of the medical literature was undertaken to determine cause, diagnosis, prognosis, treatment and prevention of injuries resulting from birth trauma. The primary focus was the neonate, though infant, child and adult were also considered because the effects of birth trauma can be life-long. DATA SOURCE: A compilation of case studies and review articles were extracted from numerous "MEDLINE" literature searches. Key Terms included: Birth Trauma, Central Nervous System Injuries, Musculoskeletal Injuries, Stillbirth, Sudden Infant Death Syndrome (SIDS), Cerebral Palsy, Brachial Plexus Palsies (Erb's and Klumpke's), Neonatal-Infantile Respiratory Distress, Obstetric Accidents (Forceps, Vacuum Cup and Cesarean Deliveries), Subluxation, Chiropractic Treatment. American, British, Danish and German studies were included to show the universality of the problem. STUDY SELECTION: Findings were selected on the basis of a clear connection between birth trauma and the resulting symptoms, syndromes and/or death. DATA EXTRACTION: Findings were compiled by studying articles from the literature search. The quality and validity were assessed by corresponding references, method of documentation, number of case studies, length of time over which studies took place and presence of follow-up documentation. DATA SYNTHESIS: Inadequacies and source discrepancies were also included with regard to cause and types of obstetric accidents. CONCLUSION: Birth trauma remains an underpublicized and, therefore, an undertreated problem. There is a need for further documentation and especially more studies directed toward prevention. In the meantime, manual treatment of birth trauma injuries to the neuromusculoskeletal system could be beneficial to many patients not now receiving such treatment, and it is well within the means of current practice in chiropractic and manual medicine.

Adolescent↗
PubMed2005

Traumatic experience with vacuum extraction--influence of personal preparation, physiology, and treatment during labor.

OBJECTIVE: To assess pre-labor attitudes and post-labor experiences of the use of vacuum extraction during delivery. To seek associations between traumatic labor experience and personal preparation, physiology of labor and treatment during labor. METHODS: A total of 205 women filled in a questionnaire within five days of vacuum extraction delivery. The questionnaire was designed to distinguish the group of women having experienced their labor as traumatic from those not having such an experience. The association between explanatory variables grouped as background factors, physiological factors of labor and treatment-related factors in relation to traumatic experience status was studied by bivariate analysis by the chi-square test or Student's t-test. Logistic regression analysis was carried out to examine simultaneous effects of factors. In the first phase, each of the previously chosen groups was analyzed separately, and in the second, all risk factors thus emerging as significant were entered into the final model. RESULTS: Forty-two women (20%) regarded their childbirth experience as traumatic. Of the background factors, insufficient pre-labor training and a pre-labor desire for extra strong pain relief during the coming labor were significantly more common in the traumatic birth group. Of the physiological factors of labor, unsatisfactory pain relief and a difficult third stage of labor were associated with a traumatic birth experience. The treatment-related factors showed mutual correlation and were strongly associated with birth experience. After logistic regression analysis only four independent risk factors emerged as significant: insufficient support immediately after delivery, the experience of being poorly listened to during labor, insufficient doctor's support during the first stage of labor, and pre-labor training classes considered insufficient. CONCLUSIONS: Treatment-related factors were the most powerful predictors of an adverse birth experience after vacuum extraction delivery, exceeding those related to labor physiology. Thus, the role of treatment and care before, during and after vacuum extraction is emphasized.

Adult↗
PubMedDate not supplied

A comparison of pregnancy care delivered by family physicians versus obstetricians in Lebanon.

BACKGROUND: The provision of prenatal and intrapartum care is an important issue in family practice. Physician specialty as a risk factor for adverse perinatal outcome is of interest to both educators and patients. The purpose of this study is to compare perinatal care provided by family practice and obstetrics residents for low-risk women in Lebanon. METHODS: A study of 400 matched pairs of low-risk pregnant women was conducted at the American University of Beirut Medical Center to compare outcomes of perinatal care provided by family physicians and obstetricians. The medical records of women admitted for delivery at the American University of Beirut Medical Center between October 1, 1986, and October 1, 1990, were reviewed. RESULTS: Obstetricians used oxytocin induction significantly more frequently than family physicians (43% versus 7%, P < .01). A similar significant difference was also noted for artificial rupture of membranes. There were similar episiotomy rates (63%), with a greater number of lacerations reported among women cared for by obstetricians (28% versus 15%, P < .05). The use of forceps was similar in both groups. Vacuum extraction was not used by family physicians. Neonatal outcomes were comparable, although meconium-stained amniotic fluid was more common in the obstetrics group (21% versus 6%, P < .05). During the postpartum period, significantly more women breast-fed (62% versus 45%, P < .01) and used oral contraceptives in the family practice group. CONCLUSIONS: When caring for low-risk pregnant women, family physicians appear to provide comparable care with less intervention than obstetricians.

Adolescent↗
PubMedDate not supplied

The practice of obstetrics by Army family physicians.

BACKGROUND: There has been a dramatic decline nationwide in family physicians practicing obstetrics. This study describes the practice of obstetrics by Army family physicians in an environment relatively free of malpractice liability and other financial concerns. METHODS: A questionnaire was mailed to every family physician on active duty in the Army (n = 334) in 1993, with a final response rate of 79 percent (n = 265). RESULTS: Nearly 73 percent of Army family physicians practice obstetrics. Almost all believed they were adequately prepared to provide routine prenatal care (98 percent) and complicated obstetric care (84 percent). More than 95 percent of those assigned to a teaching facility delivered babies. Obstetric procedures that the majority performed included normal vaginal deliveries (100 percent), repair of third-degree (98 percent) and fourth-degree (93 percent) tears, insertion of fetal scalp electrodes (96 percent) and intrauterine pressure catheters (98 percent), interpretation of nonstress tests (97 percent) and contraction stress tests (83 percent), vacuum extractions (93 percent), pudendal or paracervical blocks (88 percent), first assist in Cesarean sections (80 percent), amnioinfusions (76 percent), and low-forceps deliveries (53 percent). Those who currently practice obstetrics were more satisfied with being a family physician compared with those who did not practice obstetrics (95 percent vs 86 percent, P < 0.02). CONCLUSIONS: The majority of Army family physicians perform a wide spectrum of obstetrics care. Those who practiced obstetrics were generally more satisfied with family practice than were those who did not practice obstetrics.

Adult↗
PubMed2000

Obstetric complications and asthma in childhood.

Studies have shown that perinatal factors are associated with childhood asthma. The current analyses examined the association between obstetric complications and risk of asthma at the age of 7 years using a prospectively population-based birth cohort in northern Finland. Results indicated that obstetric complications were associated with a higher risk of asthma among children. Those children who were administered special procedures at birth, i.e., cesarean section, vacuum extraction, and other procedures, including use of forceps, manual auxiliary, and extraction breech, had an adjusted odds ratio (OR) for asthma of 1.38 (95% confidence interval [CI] 1.00-1.92), 1.32 (95% CI 0.80-2.19), and 2.14 (95% CI 1.06-4.33), respectively, as compared to children who were delivered normally. Children who had a lower Apgar score at the first and the fifth minute after birth also had a higher risk as compared to those who had an Apgar score of 9-10. The results encourage further evaluation of the association between obstetric complications and risk of asthma among children in other populations, and further exploration of possible mechanisms underlying the association.

Adult↗
PubMed1994

Deaths associated with intrapartum asphyxia in Jamaica.

The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10,086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44% of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post-mortem examination where it had been carried out. About half of these babies weighted 2500 g+ and death should have been largely preventable. Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first diastolic blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were substantial reductions in mortality in areas where better medical facilities were available. To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination. Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be appropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful.

Asphyxia Neonatorum↗
PubMed1996

[Adolescence and pregnancy in Guadeloupe. 184 cases].

Maternal pregnancy complications and pregnancy outcomes of all adolescent pregnancies (< 18 years; n = 184) during a two year survey (1993-1994) at the Maternity of University Hospital of Pointe-á-Pitre, Guadeloupe, French West Indies, were compared to that of an older cohort (20-35 years; n = 3938). there were no statistical differences between the two groups in obstetrical complications (infections, hypertension, fetal deaths), birthweight, gestational age at delivery or apgar scores at birth. Adolescents were more likely to have mechanical extractions (forceps, vacuum) and less cesarean sections although differences were not significant. On the other hand, prenatal care was significantly poorer in adolescents. These results are in accordance with the literature. It remains that the adolescent pregnancy rate is higher in Guadeloupe as compared to Europe or mainland France. Although these data do not suggest an elevated reproductive health risk for adolescents, it does inflict a social burden of decreased potential for productivity.

Adolescent↗