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The authors report a case of brachial paralysis and paralysis of the right hemidiaphragm which followed a favorable course. Comments are made on the symptomatology and course of the disease.
The paper deals with the effect of the delivery technique used on perinatal mortality and neonatal morbidity rates. Overall mortality of 236 underweight breech babies (less than 2,500 g) and a number of morbidity parameters of 68 new-born children of 1,000 to 2,000 g birth weight are studied collected over a period of comparable perinatological management. The results show that cesarean section is the most favourable technique for children of 1,000 to 2,000 g birth weight. To do so, it is necessary to exclude non-viable malformations prenatally and to ensure a reliable neonatological intensive care. Another major problem is to prevent premature birth. On the basis of the results obtained and taking into account anamnestic and obstetrical risks, we give preference to an adequate selective section to deliver underweight children from breech presentation, but do not rule out vaginal methods of delivery using good techniques and proceeding as carefully as possible.
Adding together the obstetric histories and the urodynamic investigations carried out on 178 incontinent women has made it possible for the authors to work out the role that obstetric trauma can play in urinary symptoms. They are able to demonstrate the effects of repeated normal deliveries and also the results of traumata over and above those that occur physiologically and are sometimes undergone by the perineum.
Recent obstetrical practice trends in 12 countries were surveyed. There was a 3-fold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia, Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.
OBJECTIVE: To examine the association of the frequency and severity of perineal trauma with episiotomy performed at forceps delivery. STUDY DESIGN: This retrospective study analyzed all forceps deliveries at the Semmelweis Women's Hospital Vienna between February 1999 and July 1999. Evaluation of a possible association of episiotomy with the frequency and severity of perineal trauma was the main objective of the study. Episiotomy was not performed routinely and was either midline or mediolateral. RESULTS: In conjunction with forceps delivery episiotomy, 76/87 women (87%) underwent forceps delivery episiotomy; among those, 49/76 (64%) had a mediolateral episiotomy and 27/76 (36%) a midline episiotomy. The frequency and severity of perineal tears were significantly lower in forceps deliveries when an episiotomy was performed. When analyzing the type of episiotomy, the data revealed a statistically significantly lower frequency of perineal trauma when mediolateral episiotomy was performed as compared to midline episiotomy. CONCLUSION: If obstetric indications necessitate forceps delivery, performance of an episiotomy decreases the risk of perineal tears of all degrees. When analyzing the type of episiotomy, mediolateral episiotomy seems to be more protective against perineal trauma in women undergoing forceps delivery.
OBJECTIVE: The aim of this review was to determine whether intrapartum admission cardiotocography (CTG) in women at low obstetric risk can improve neonatal outcome (in terms of Apgar score) and whether it is associated with an increase in the incidence of instrumental delivery and caesarean section. REVIEW METHODS: The Cochrane Library, Medline (1966-November 2005), Embase (1980-November 2005) and the PubMed were searched for randomized control trials and systematic reviews of randomized control trials. Studies were assessed for quality. Outcomes considered the neonatal Apgar score at 5 min after delivery, caesarean section and instrumental delivery. A meta-analysis of the results of the randomized controlled trials was performed. RESULTS: The pooled relative risk for having an Apgar score less than 7 points at 5 min after delivery was higher in the admission CTG group (RR 1.35, 95% CI 0.85-2.13) but it was not statistically significant. The pooled relative risks for having a caesarean section-delivery (RR 1.2 95% CI 1.00-1.41) and an instrumental delivery (RR 1.1 95% CI 1.00-1.18) were both higher in the admission CTG group. Both these were statistically significant. CONCLUSION: Intrapartum admission cardiotocography in women at low obstetric risk increases the risk of caesarean section and instrumental delivery. In addition, there is no evidence for neonatal benefit in terms of Apgar score at 5 min after delivery. A larger sample size would be needed in order to answer this important question.
An 8-year study of urinary fistulae from 1974 to 1981 was done in the University Teaching Hospital, Lusaka, Zambia. The analysis revealed no significant decrease in the number of urinary fistulae referred to the Department of Obstetrics and Gynaecology of the University during the period. Of 61 cases reviewed, 54 were consequent to obstetrical trauma of prolonged labor and superimposed operation or instrumentation. Four fistulae occurred as a complication of gynecologic surgery, while three originated from advanced malignancy of the cervix. Operative management of fistulae is discussed. Further reorganization of rural maternity services in Zambia is suggested as a preventive measure.
Occipito-posterior persistent presentation is a relatively rare obstetrical condition, occurring in 2 to 4.5% of deliveries. Failure of the occiput to spontaneously rotate has been associated with increased maternal and neonatal morbidity. We performed a retrospective study of 210 vaginal occiput posterior deliveries to investigate the influence of this position on maternal and fetal morbidity. Our results demonstrate that overall prognosis of occipito-posterior persistent presentation is good but less auspicious than occipito-anterior presentation on account of importance of perineal injuries and maternal and fetal infections. Forceps extraction in posterior presentation is criticized today. In our opinion, the vacuum extractor is the better instrument because it is less aggressive to maternal tissues and also because, in most cases, the fetal head rotates anteriorly after provoked flexion.
In a prospective study the spectrum of bacteriological organisms in the uterus was analysed within the first 3 days post partum. Smears were taken from the ectocervix and from the cavum uteri from 80 asymptomatic puerperae (70 had delivered spontaneously and 10 had had a vaginal-operative delivery). The smears were achieved using an endometrium catheter with a pilot cap. After the specialised sampling had been undertaken, in 47 of the 70 patients with spontaneous delivery and in 1 of the patients with operative delivery, no bacterial invasion was found in the cavum uteri. After prophylactic administration of antibiotics prenatally, bacterial organisms were found significantly less often (p < 0.05). On the other hand, intrauterine bacterial organisms were found significantly more frequently in patients who had had cervix priming with PGE2 and where foetal blood analysis had been performed sub partum (p < 0.05). Contrary to the smears from the cavum uteri, all ectocervical smears were positive. In 13 of 23 cases with positive proof of intrauterine bacterial organisms, a difference was found in the bacteriological spectrum compared with the parallel cervical smear taken. Further obstetrical factors play a role in influencing the bacterial invasion, however, there were no complications in any of the cases due to the smears being taken and no infections were observed during the rest of the lying-in period.
In connection with the vaginal delivery of twins, different opinions exist among obstetricians as to whether the time interval between the birth of both twins influences the often reported higher perinatal mortality and morbidity of the second twin. During the period from January 1, 1982, to December 12, 1987, we had 176 twin deliveries (1.5%), among a total number of 11,395, from which, after vaginal birth of twin A, in 96 cases twin B was born alive. In this study group, we analysed retrospectively our active obstetrical management in respect of relations between time interval on the one hand and perinatal mortality, operation frequency and foetal outcome of the second born twin on the other. The perinatal mortality rate, as defined by the WHO was 4.2% and excluding stillborns and children with a birth weight of less than 1,000 g, only 0.3%. We could not identify the influence of the time interval on perinatal mortality, which was equal for both twins. The frequency of surgical interventions rose from 12.8% when twin B was born within 20 min, to 38.8% when it was delivered after this time interval. An adverse foetal outcome judged by APGAR-score could not be proved. Shortening the time interval by active obstetrical management is of value in order to reduce potential risks for the mother and the second born twin, but it should be borne in mind, that the results of our study are positively influenced by the primary selection criteria of mode of delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVES: Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed. RESULTS: Initially all women were in Functional Class I or II. Worsening during pregnancy occurred in 25.5% (n=27), mainly during the second and third trimester. Significant problems due to bleeding, hypertension, rhythm disturbances, endocarditis, liver congestion, increasing cyanosis or death, occurred in 11.3%. Twelve per cent of deliveries were premature. Five women had therapeutic abortion, nine spontaneous abortions, nine preterm births, and one intrauterine death. Seventy-nine per cent (n=85) delivered spontaneously; 21.3% (n=23) had caesarean section. Of the 111 live born children, 5.4% (n=6) had a CCD. CONCLUSIONS: Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.
Experience in using Barton's forceps for mid-pelvic arrest of the fetal head in 348 cases has proved that this instrument is both easy to apply and safe for the baby, provided rigid adherence to safety criteria are observed. As modern obstetric practice is favourably disposed towards mid-pelvic forceps vaginal delivery, the particular advantages of Barton's forceps should be more widely extolled. Their use is an invaluable addition to the obstetrician's armamentarium. Training in their use should, however, be thorough and extensive and under the guidance of a skilled senior obstetrician.
METHODS: A retrospective study of 733 nulliparous women who gave birth at the Department of Obstetrics and Gynecology at the University of Bari, in the period from 1-1-1994 to 31-12-1995, was performed to evaluate the outcome of pregnancy and neonatal outcome in adolescents < or = 18 years old. The sample was subdivided into two subgroups; the first of 114 girls < or = 18 years old; the latter of 619 women 22-34 years of age, and they were compared. RESULTS: We have found a more lengthy term of pregnancy (39.66 weeks vs 39.27 weeks p = 0.008) and a greater incidence of vacuum extraction (VE) in the group of < or = 18 years old (7.89% vs 3.23% p = 0.03).
The relationship between fetal head compression and the occurrence of intraventricular hemorrhage was examined in 101 very-low-birth-weight (500 to 1500 g) vertex neonates. Peripartum events related to head compression, including parity, rupture of membranes, labor, episiotomy, use of forceps, and cesarean birth were not significantly related to intraventricular hemorrhage. A birth weight of less than 1250 g, neonatal depression (one minute Apgar score less than 7), respiratory distress syndrome, and neonatal mortality were significantly associated with intraventricular hemorrhage (P less than .05). These findings suggest that head compression in the vertex very-low-birth-weight fetus, as encountered in current obstetric practice, is not a major determinant of intraventricular hemorrhage. When premature delivery is inevitable, focusing on efforts to avoid a depressed one-minute Apgar score appears to be a more promising approach for the prevention of intraventricular hemorrhage than routinely using cesarean birth.
On the basis of qqq 32 cases of rupture of the uterus observed over a 5-year period at the Monastir University hospital (Tunisia), the authors recall the high incidence of this obstetrical emergency: 1 incident per 548 deliveries. The usual aetiological factors were present: multiparity, caesarean scar, mechanical dystocia, oxytocic dystocia and obstetric manoeuvres. The foeto-maternal prognosis is poor with a maternal mortality rate of 3.13% and a perinatal mortality rate of 46.9%. Treatment should be conservative whenever possible. The authors attempt to define a prophylactic approach on the basis of the aetiological context.
OBJECTIVES: To investigate the relationships between various obstetric parameters and postpartum urinary retention, and to offer some clinical guidance for resolution of urinary retention problems. DESIGN: An observational prospective study. SETTING: A private teaching hospital medical centre. POPULATION: A total of 2,866 vaginally delivered women were recruited with 114 women classified as urinary retention group and the remaining 2752 women categorised as control group. MAIN OUTCOME MEASURES AND RESULTS: Women in the urinary retention and control groups did not differ significantly in terms of age, fetal head circumference and fetal birth weight. Women suffering from postpartum urinary retention demonstrated significantly longer labour duration, more nulliparity and epidural analgesia and higher percentages of instrument-assisted delivery and vaginal or perineal damage. CONCLUSION: Nulliparity, longer labour course, instrumental delivery, extensive vaginal and perineal laceration and use of epidural analgesia were contributing obstetric factors to postpartum urinary retention. Long-term follow-up showed that the problems of all but three of the 114 women, who complained of persistent minor urinary symptoms, were eventually resolved.
This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.
OBJECTIVE: To examine birth outcomes and pregnancy complications in women with a history of anorexia nervosa. DESIGN: Prospective cohort study. SETTING: Nationwide study in Sweden. POPULATION: All primiparous women--discharged from hospital with a diagnosis of anorexia nervosa during 1973 to 1996--who gave birth during 1983 to 2002 (n = 1000) were compared with all non-anorexia nervosa primiparous women who gave birth during the same years (n = 827,582). METHOD: Register study with data from Medical Birth Registry and National Patient Discharge Register. MAIN OUTCOME MEASURES: Pre-eclampsia, instrumental delivery, prematurity, small for gestational age, birthweight, Apgar score and perinatal mortality. RESULTS: Main birth outcome measures in women with a history of anorexia nervosa were very similar to the main population. The only observed differences were a slightly lower mean birthweight and lower adjusted odds ratios for instrumental delivery in the anorexia nervosa group compared with the main population. Neither severity of the disease nor a shorter recovery phase after first hospitalisation was related to pregnancy complications or birth outcomes. CONCLUSION: A history of anorexia nervosa was not associated with negative birth outcomes. Thus, special obstetric monitoring of pregnant women with history of anorexia nervosa does not seem to be warranted in a country with a satisfactory maternity surveillance.