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At least 1,279 records · Page 71Linked to original sources
PubMed1994

Vaginal birth after cesarean section in a university setting.

Despite numerous reports in the literature almost universally endorsing the safety of a trial of labor after a prior cesarean section, it is used in only a small fraction of eligible patients. Our investigation, conducted at the University of Louisville, examines the safety of such a protocol. Two thousand seven hundred fifty-seven patients were delivered during one year; 282 had a history of at least one prior cesarean section. Of the 259 patients eligible, 218 (84%) underwent a trial of labor, and 168/218 (77%) were delivered vaginally. There were 6 cases of uterine dehiscence and 1 uterine rupture. No hysterectomies were performed. Maternal morbidity was significantly greater in the failed trial-of-labor group. There was one perinatal death that was unrelated to a trial of labor. A previous diagnosis of cephalopelvic disproportion or failure to progress did not preclude a trial of labor, and 69% of these patients delivered vaginally. Our data suggest that a trial of labor following one or more previous cesarean sections is a safe option in a carefully selected population.

Cesarean Section↗
PubMed1993

Breech delivery at term: a critical review of the literature.

OBJECTIVE: To determine whether planned vaginal or elective cesarean delivery is better for singleton term breech infants. DATA SOURCES: Articles that included singleton term pregnancies with breech presentation published in English between 1966 and September 1992 were searched through the Index Medicus, Oxford Database of Perinatal Trials, and MEDLINE. METHODS OF STUDY SELECTION: We reviewed 24 studies that presented results according to the intended mode of delivery in terms of the following adverse outcomes: perinatal mortality, low 5-minute Apgar score, traumatic neonatal morbidity, overall short-term neonatal morbidity, long-term infant morbidity, and maternal morbidity and mortality. DATA EXTRACTION AND SYNTHESIS: The effect of planned vaginal delivery, compared with planned cesarean delivery, for each adverse outcome was determined by calculating a typical odds ratio. Perinatal mortality was higher for the planned vaginal delivery groups than for the elective cesarean groups, with a typical odds ratio of 3.86 (95% confidence interval [CI] 2.22-6.69). Neonatal morbidity due to trauma was also higher for the planned vaginal delivery groups, with a typical odds ratio of 3.96 (95% CI 2.76-5.67). CONCLUSION: The results suggest that planned vaginal delivery may be associated with higher perinatal mortality and morbidity rates than planned cesarean delivery. Because of selection bias in the majority of studies, differences in outcomes may be due to factors other than the planned method of delivery. An appropriately sized, randomized controlled trial is needed to answer this question definitively.

Breech Presentation↗
PubMed1996

Laser "miniconisation' and the outcome of subsequent pregnancy.

We routinely use the carbon dioxide laser miniconisation procedure for cervical interepithelial neoplasia I-III. A retrospective case control study was conducted in 1,485 miniconised women during 250 subsequent pregnancies (including three twin pregnancies). The analysis showed that the miniconised subjects had no significant pregnancy complications and the same preterm birth ratio (8.0%) as controls matched for age and parity.

Adolescent↗
PubMed1975

The Cape Town obstetric flying squad.

The number and nature of the calls received by the Cape Town Flying Squad Service during 1972 are compared with those received from 1954 to 1960. A threefold increase in the total number of calls received per year is related to a fall from 74% to 30% in calls connected with postpartum complications. Reasons for these changes are suggested.

Delivery, Obstetric↗
PubMedDate not supplied

Effect of three concentrations of intracervical prostaglandin E2 gel for cervical ripening.

To evaluate the efficacy and safety of three concentrations of prostaglandin E2 (PGE2) gel for preinduction cervical ripening. Two hundred ninety-one patients with an unfavorable cervix scheduled for induction of labor were eligible to participate in a prospective, randomized, double-blind study of one or two doses of intracervical PGE2 gel. Group 1 received a dose of 0.125 mg/2 ml; group 2 received 0.25 mg/2 ml; and group 3 received 0.5 mg/2 ml. Outcome variables included change in Bishop score, uterine tachysystole, oxytocin use, route of delivery, and maternal and neonatal complications. Two hundred twenty-nine patients were included in the study, 79 in group 1, 70 in group 2, and 80 in group 3. Among the three groups, no statistically significant differences were noted for change in Bishop score, uterine tachysystole, oxytocin use, route of delivery, or incidence of maternal or neonatal complications, Subsequent labors were frequently complicated by fetal heart rate abnormalities (24.3%) and uterine tachysystole (9.6%); 84 (38.9%) patients were delivered by cesarean section. A dose-dependent influence on outcome variables was not identified. Complications from PGE2-ripening within 4 hours of gel application were not dose dependent and occurred infrequently. This study demonstrates that there is no dose in the range tested that assures an absences of tachysystole, limiting the role of outpatient cervical ripening without some period of observation.

Adult↗
PubMed1990

Fetal acoustic stimulation in the early intrapartum period as a predictor of subsequent fetal condition.

Fetal acoustic stimulation has recently received much attention in the literature. This study evaluates fetal acoustic stimulation in the early intrapartum period as a predictor of subsequent fetal condition. The study group consisted of 201 patients, approximately 60% of whom had complicated pregnancies. All were in the latent phase of labor with singleton, vertex-presenting fetuses. Gestational age ranged from 37 to 43 weeks. Fourteen of the 201 fetuses (7%) showed a nonreactive response to fetal acoustic stimulation and those fetuses were at significantly greater risk of initial and subsequent abnormal fetal heart rate patterns, meconium staining, and cesarean delivery because of fetal distress and Apgar scores less than 7 at both 1 and 5 minutes. Transient fetal heart rate decelerations after a reactive response occurred in 25% of patients; however, fetal outcome was not worse in this group. A reactive response to fetal acoustic stimulation was associated with high specificity and negative predictive values. Therefore we conclude that fetal acoustic stimulation in the early intraprtum period may discriminate the compromised from the noncompromised fetus.

Acoustic Stimulation↗