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At least 1,207 records · Page 67Linked to original sources
PubMed2001

Prevention of childbirth injuries to the pelvic floor.

The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility.

Cesarean Section↗
PubMed1996

[Influence of maternal neuropsychiatric disorders on clinical course of pregnancy and neonatal outcome].

The obstetric course and neonatal outcome were studied in 35 pregnant women with neuropsychiatric disorders who were admitted to Toho University Ohmori Hospital between 1981 and 1990. The rate of live births associated with psychiatric disease was 0.49% (40 of 8.191 deliveries). These were schizophrenia (N = 17), epilepsy (N = 12), depression (N = 2), neurosis (N = 3) and psychogenic response (N = 1). Iron deficiency anemia was observed in 8 of 16 epileptic women. Cesarean section or vacuum extraction were performed in 15 of 40 cases (37.5%). The indications for these procedures were uncontrollable psychotic symptoms in all of 6 schizophrenic women, while those in all 7 epileptic women were obstetrical. Symptoms of schizophrenia became worse in 33.3% and 50% of the patients during and after birth, respectively. The incidence of preterm delivery was 15%, and 25% of newborn infants were of low birthweight. Drug withdrawal symptoms were observed in 4 of 16 infants (25%) born to epileptic mothers. Three of 10 offspring of epileptic mothers were affected by febrile convulsions within 6 years of age. Although a relatively higher incidence of obstetric complications has recognized, there seem to be no specific complications in epileptic or psychiatric women. Our results also suggest the importance and need for close cooperation between the obstetrician and psychiatrist, and a follow-up program for offspring.

Cesarean Section↗
PubMed2006

Obstetric anal sphincter rupture in older primiparous women: a case-control study.

OBJECTIVE: To determine if maternal age (35 years of age or older) in primiparous women is a risk factor for the development of obstetric anal sphincter rupture (OASR) and to identify obstetric factors associated with it. MATERIAL AND METHODS: This is a retrospective case-control study. The study population was made up of the 5,345 primiparous women aged 24-45 years who delivered vaginally with singleton live-born neonates during 1990-99 at the Department of Obstetrics and Gynecology, Linköping University Hospital, Sweden. As cases the 327 primiparous women aged 35-45 years at delivery were selected. For each case two primiparous controls ten years younger were selected, matched for gestational age and year of delivery, in all 654 controls. Maternal, obstetrical, and neonatal data were obtained from the delivery records. Obstetric factors for the development of OASR were assessed with multivariate logistic regression analysis. RESULTS: No significant association was found between the primiparous age category and OASR. Vacuum extraction, forceps delivery, and the head circumference of the neonate were found to be independent risk factors for OASR, while the use of mediolateral episiotomy or epidural analgesia were independent protective factors for developing OASR. CONCLUSIONS: Primiparous women, 35 years of age or older, do not seem to have a greater risk of OASR than younger primiparous women. Risk factors for OASR are instrumental vaginal delivery and the size of the neonate. Mediolateral episiotomy and epidural analgesia seem to reduce the risk for OASR.

Adult↗
PubMed2006

Risk factors for obstetric anal sphincter injury: a prospective study.

BACKGROUND: Anal incontinence is an embarrassing condition that is largely underreported. Obstetric anal sphincter injuries are the major etiological factor. Recognition of risk factors may minimize the development of sphincter injuries. The objective of this study was to identify risk factors for sphincter injuries and measure dimensions of mediolateral episiotomies. METHODS: Women expecting their first vaginal delivery were invited to participate, and an experienced research fellow performed a perineal and rectal examination and classified tears according to the new international classification. Dimensions of episiotomies were measured and obstetric variables recorded prospectively. RESULTS: Of the 241 women recruited, 59 (25%) sustained sphincter injuries. Univariate analysis revealed that forceps delivery OR 4.03 (1.63-9.92), vacuum extraction OR 2.64 (1.25-5.54), gestation > 40 weeks OR 3.18 (2.35-4.29), and mediolateral episiotomy OR 5.0 (2.64-9.44) were associated with these injuries. In addition, compared with women who had no injuries, sphincter injuries were more common with higher birthweight (3.51 vs 3.17 kg, p < 0.01), larger head circumference (34.3 vs 33.3 cm, p < 0.01), and longer second stage of labor (76 vs 51 min, p < 0.01). Multiple logistic regression revealed higher birthweight and mediolateral episiotomy OR 4.04 (1.71-9.56) as independent risk factors. Episiotomies angled closer to the midline were significantly associated with such injuries (26 vs 37 degrees, p = 0.01). No midwife and only 13 (22%) doctors performed truly mediolateral episiotomies. CONCLUSIONS: Mediolateral episiotomy is an independent risk factor for anal sphincter injuries. Although a liberal policy of mediolateral episiotomy does not appear to reduce the risk of such injuries, it may be related to inappropriate technique. A concerted approach to educate trainees in appropriate episiotomy technique and identification of sphincter injuries is imperative to enable reexamination of the true merits or disadvantages of mediolateral episiotomy.

Anal Canal↗
PubMed1997

The Stockholm birth centre trial: maternal and infant outcome.

OBJECTIVE: To compare an in-hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome. BACKGROUND: The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth. METHODS: Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention-to-treat. RESULTS: Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P = 0.11). Subgroup analysis showed that a larger proportion of first-born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P = 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P = 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P = 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group. CONCLUSION: Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas' infants in the birth centre group gives cause for concern and necessitates further studies.

Adult↗