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At least 1,225 records · Page 68Linked to original sources
PubMed2006

Maternal complications of pregnancy increase beyond 40 weeks of gestation in low-risk women.

OBJECTIVE: We sought to determine when rates of maternal pregnancy complications increase for low-risk nulliparous and multiparous women at term. METHODS: We designed a retrospective cohort study of low-risk women delivered beyond 37 weeks gestational age from 1976 to 2001. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariate analyses. Statistical significance was designated by P<0.05. RESULTS: We found that among the 32,828 low-risk women who delivered at 37 completed weeks and beyond, the rates of primary cesarean delivery, operative vaginal delivery, third- or fourth-degree perineal lacerations, and chorioamnionitis all increased at 40 weeks of gestation (P<0.001), and the rate of postpartum hemorrhage increased at 41 weeks of gestation (P<0.001). These increases of rates of complications were larger and increased at an earlier gestational age among nulliparous women. CONCLUSION: We found that the risk of maternal complications for otherwise low risk nulliparous and multiparous women increased as pregnancy progressed beyond 40 weeks of gestation. Counseling of women who progress past their EDC should include comparing the risks of induction of labor to that of expectant management.

Adult↗
PubMed1985

Perinatal events and intraventricular/subependymal hemorrhage in the very low-birth weight infant.

One hundred nineteen very low-birth weight infants were studied to see whether intrapartum fetal distress with or without acidosis correlated with the development of intraventricular and subependymal hemorrhage. Of 112 infants studied prospectively, 24% (27/112) had intraventricular/subependymal hemorrhage documented by real-time ultrasound studies shortly after birth; only 4.4 (5/112) had severe hemorrhage (grade 3/4). Ominous fetal heart rate patterns occurred in 50% of monitored infants with severe intraventricular/subependymal hemorrhage compared to 8% of matched controls (p less than 0.01). Reassuring fetal heart rate patterns were more predominant in infants without intraventricular/subependymal hemorrhage (p less than 0.05). Neonatal depression and the need for assisted ventilation beyond the immediate delivery period were more frequent in infants who developed intraventricular/subependymal hemorrhage. Antepartum and intrapartum complications, fetal presentation, cesarean section, duration of labor, hyaline membrane disease, and volume expansion appeared to play no role in the incidence of intraventricular/subependymal hemorrhage. Preliminary data presented here suggest that intrapartum fetal distress and acidosis may be significant factors in predicting which very low-birth weight infant will develop intraventricular/subependymal hemorrhage. The condition of the infant at birth may be more significant with respect to the extent of intraventricular/subependymal hemorrhage than a variety of obstetric variables. Aggressive management of appropriately selected patients and judicious resuscitation of the very low-birth weight infant may keep the incidence of severe intraventricular/subependymal hemorrhage at a minimum, thereby optimizing neurological outcome for this high-risk group.

Acidosis↗
PubMed2005

Association of nonreassuring fetal heart rate patterns and subsequent cerebral palsy in pregnancies with intrauterine bacterial infection.

We evaluated an association of nonreassuring fetal heart rate (FHR) patterns and subsequent cerebral palsy (CP) in pregnancies with intrauterine bacterial infection. Among 10,030 infants born during 1995 to 2000, 139 were complicated with acute intrauterine bacterial infection in labor. The FHR patterns 2 hours immediately before delivery were interpreted according to the guidelines of the National Institute of Child Health and Human Development. The correlations between the FHR patterns and umbilical blood gases, as well as FHR patterns and CP were studied. Statistics included unpaired t test, contingency table with chi (2) and Fisher test, and one-way analysis of variance with Bonferroni/Dunn test. Fifteen infants (11%) developed CP at 2 years or older. Nonreassuring FHR patterns including recurrent late deceleration, severe variable deceleration, and prolonged deceleration occurred in 24% of pregnancies with intrauterine infection. Incidence of CP was not different according to the FHR deceleration patterns or umbilical pH values. Multiple logistic regression analysis revealed that fetal tachycardia (OR, 11; 95% CI, 1.8 to 67) and lower gestational age (< 34 weeks; OR, 9.4; 95% CI, 0.96 to 93) was associated with CP in intrauterine infection. Nonreassuring FHR patterns were increased in intrauterine infection. CP occurred more frequently and was associated with tachycardia and lower gestational age, but not with FHR deceleration patterns or acidemia, suggesting different pathophysiology from acute hypoxia-ischemia.

Cerebral Palsy↗
PubMedDate not supplied

Obstetrical complications and violent delinquency: testing two developmental pathways.

This study focused on the interaction between specific obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence, in a sample of 849 boys from low socioeconomic areas of Montreal, Canada. Obstetrical complication data from medical records were used to create three scales using a nonlinear principal component analysis followed by rotation. Family adversity and teacher-rated physical aggression were assessed when the boys were in kindergarten and self-reports of delinquency were collected when they were 17. Elevated scores on the Deadly Risk Situation scale of obstetrical complications (preeclampsia, umbilical cord prolapse, and induced labor) increased the risk of being violent at both 6 and 17 years of age, only among boys who grew up in high adverse familial environments. Moreover, this interaction partly accounted for the continuity between violence in childhood and adolescence. Interventions for young pregnant women from deprived environments and their babies are discussed in light of these results.

Adolescent↗
PubMed1999

Pregnant women benefit from massage therapy.

Twenty-six pregnant women were assigned to a massage therapy or a relaxation therapy group for 5 weeks. The therapies consisted of 20-min sessions twice a week. Both groups reported feeling less anxious after the first session and less leg pain after the first and last session. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study. In addition, urinary stress hormone levels (norepinephrine) decreased for the massage therapy group and the women had fewer complications during labor and their infants had fewer postnatal complications (e.g., less prematurity).

Adult↗
PubMed2003

Persistent fetal occiput posterior position: obstetric outcomes.

OBJECTIVE: To evaluate the obstetric outcomes associated with persistent occiput posterior position of the fetal head in term laboring patients. METHODS: We performed a cohort study of 6434 consecutive, term, vertex, laboring nulliparous and multiparous patients, comparing those who delivered infants in the occiput posterior position with those who delivered in the occiput anterior position. We examined maternal demographics, labor and delivery characteristics, and maternal and neonatal outcomes. RESULTS: The prevalence of persistent occiput posterior position at delivery was 5.5% overall, 7.2% in nulliparas, and 4.0% in multiparas (P <.001). Persistent occiput posterior position was associated with shorter maternal stature and prior cesarean delivery. During labor and delivery, the occiput posterior position was associated with prolonged first and second stages of labor, oxytocin augmentation, use of epidural analgesia, chorioamnionitis, assisted vaginal delivery, third and fourth degree perineal lacerations, cesarean delivery, excessive blood loss, and postpartum infection. Newborns had lower 1-minute Apgar scores, but showed no differences in 5-minute Apgar scores, gestational age, or birth weight. CONCLUSION: Persistent occiput posterior position is associated with a higher rate of complications during labor and delivery. In our population, the chances that a laboring woman with persistent occiput posterior position will have a spontaneous vaginal delivery are only 26% for nulliparas and 57% for multiparas.

Apgar Score↗
PubMed1989

Twin gestations: I. Antenatal care and complications.

In order to determine the occurrence of antenatal complications in twin pregnancies, we examined the medical records of 939 consecutive twin gestations delivered at Women's Hospital, Los Angeles County/University of Southern California Medical Center between 1980-1985. The rates of occurrence of the eight most common antenatal complications were determined and compared with their incidence in singleton gestations. In addition, complication rates were related to zygosity, levels of antenatal care, and time of antenatal diagnosis. Twin gestations had an 83% incidence of antenatal complications, in contrast to a 32% incidence in singleton gestations. The increased complication rate was due to the disproportionate increase in three complications: preterm labor, pregnancy-induced hypertension, and fetal death. Other complications did not occur more frequently in twin gestations than in singleton gestations. Monozygotic gestations were more frequently complicated by fetal death, and dizygotic gestations by pregnancy-induced hypertension.

Adolescent↗