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PubMed1985

Triplet gestation: maternal and neonatal implications.

Triplet pregnancy of over 20 weeks gestation occurred 20 times during 75,506 deliveries at a referral hospital. Commonly occurring maternal complications included premature delivery (75%), antepartum anemia (35%), postpartum hemorrhage (35%), preeclampsia (20%), and premature spontaneous rupture of the membranes (20%). Malpresentation was common. Neonatal complications were also common and included respiratory distress syndrome (45%), presumptive sepsis (36.6%), hyperbilirubinemia (33%), and neonatal death (21.6%). These high complication rates emphasize the importance of early identification and referral center care for these vulnerable pregnancies.

Adult↗
PubMed1990

Delayed childbearing and the outcome of pregnancy.

Whether women who delay childbearing are at increased risk for adverse outcomes of pregnancy is of concern because of the growing proportion of first births to older women. We assessed the effect of advancing maternal age on the outcome of pregnancy in first births in a hospital-based cohort study of 3917 private patients who were 20 years of age or older with a singleton gestation. There was a slight elevation in the risk of having a low-birth-weight infant among women who were 35 years of age or older (adjusted odds ratio, 1.3; 95 percent confidence interval, 0.9 to 1.9) as compared with the risk among women 20 to 29 years of age. However, there was no evidence that women between 30 and 34 or those 35 and older had an increased risk of having a preterm delivery or of having an infant who was small for gestational age, had a low Apgar score, or died in the perinatal period. In contrast, even after controlling for sociodemographic and medical risk factors, we found that women who were 35 or older were significantly more likely to have specific antepartum and intrapartum complications and those who were 30 or older were significantly more likely to have both cesarean sections and infants who were admitted to the newborn intensive care unit. This study suggests that although older primiparous women have higher rates of complications of pregnancy and delivery, their risk of a poor neonatal outcome is not appreciably increased.

Adult↗
PubMed1976

Refractory anaemia of pregnancy as an expression of zinc deficiency.

Thirty-three gravidae with anemia in spite of iron and vitamin supplementation were examined, and 31 were found to have low or very low serum zinc concentrations with regard to the week of gestation. Twenty-three of the 33 showed no bone marrow haemosiderin or only traces. Thirty showed moderate or great increase in intracellular cell debris in the bone marrow macrophages, indicating an increase in intramedullary cell destruction. Two women showed low serum vitamin B-12 or folate concentrations and they also showed lowest zinc concentrations recorded in the series. Twelve of the 33 women gave birth to mature infants by normal delivery; 21 developed complications during labour or gave birth to immature, dysmature, or, in one case, malformed infants and/or were not delivered at normal term. Low serum zinc in pregnant women increases maternal morbidity and involves a higher risk to the fetus. It is suggested that an aetiological relationship exists between low serum zinc concentrations and refractory anaemia of pregnancy resulting in increased intramedullary cell destruction. This effect might be aggravated by iron deficiency.

Adult↗
PubMed2006

Oral health in women with pregnancy and delivery complications.

Oral health was retrospectively studied in 207 women (mean age 30 years) in the Helsinki Womens' Hospital with the hypothesis that women with pregnancy complications and/or delivery complications would present poorer dental status than women without complications. Computerized dental records of the City of Helsinki Health Department were used with decayed, missing, filled index (DMF) and community periodontal index (CPI) scoring systems and a summary dental health index (DHI) was constructed for statistics. In 72%, the delivery was uncomplicated, while 18% had Caesarean section. Of the women, 8% had gestational diabetes, 7.1% had gestational hypertension, and 1.8% had preeclampsia. Fifteen (6.6%) preterm babies were born; eight (3.5%) babies weighed <2.500 g, seven (3.2%) received a 1-min Apgar point <7 indicating less than satisfactory state of the newborn. DMF was 12.9+/-6.6 in women without complications compared to 15.3+/-6.7 in women with complications (n.s.). CPI values did not differ between the groups. The mean DHI values were 2.07 in women with normal pregnancy complications and no delivery complications, 2.23 in those with pregnancy complications, and 2.13 in those with delivery complications, respectively. In logistic regression analysis, no oral health parameters associated with any complications. Thus, this study failed to show an association between poor dental health and pregnancy or delivery complications.

Adolescent↗
PubMed2002

Risk factors and outcome of failure to progress during the first stage of labor: a population-based study.

BACKGROUND: One of the major indications for Cesarean section (CS) is failure of labor to progress. This study was aimed at defining obstetric risk factors for failure of labor to progress during the first stage, and to determine pregnancy outcome. METHODS: A population-based study comparing all singleton, vertex, term deliveries between the years 1988 and 1999 with an unscarred uterus, complicated with failure of labor to progress during the first stage with deliveries without non-progressive labor (NPL). Multiple logistic regression analysis was performed to investigate independent obstetric risk factors associated with failure of labor to progress during the first stage. RESULTS: Failure to progress during the first stage of labor complicated 1.3% (n = 1197) of all deliveries included in the study (n = 92 918), and resulted in CS. Independent risk factors for failure of labor to progress during the first stage, using a multivariable analysis, were premature rupture of membranes (PROM; OR = 3.8, 95% CI 3.2-4.5), nulliparity (OR = 3.8, 95% CI 3.3-4.3), labor induction (OR = 3.3, 95% CI 2.9-3.7), maternal age > 35 years (OR = 3.0, 95% CI 2.6-3.6), birth weight > 4 kg (OR = 2.2, 95% CI 1.8-2.7), hypertensive disorders (OR = 2.1, 95% CI 1.8-2.6), hydramnios (OR = 1.9, 95% CI 1.5-2.3), fertility treatment (OR = 1.8, 95% CI 1.4-2.4), epidural analgesia (OR = 1.6, 95% CI 1.4-1.8) and gestational diabetes (OR = 1.4, 95% CI 1.1-1.7). Although newborns delivered after failure of labor to progress during the first stage had significantly higher rates of Apgar scores lower than 7 at 1 and 5 min as compared with the controls (18.2% vs. 2.1%; P < 0.001 and 1.3% vs. 0.2%; P < 0.001, respectively), no significant differences were noted between the groups regarding perinatal mortality (0.3% vs. 0.4%; P = O.329). Maternal anemia and accordingly packed cells transfusion (47.4% vs. 22.8%; P < 0.001 and 5.6% vs. 1.0%; P < 0.001, respectively) were higher among pregnancies complicated with failure of labor to progress during the first stage as compared with the controls. CONCLUSIONS: Major risk factors for failure of labor to progress during the first stage were PROM, nulliparity, induction of labor and older maternal age. Indications for labor induction should be carefully evaluated in order to decrease the rate of operative deliveries.

Adolescent↗
PubMed1985

Expulsions in immediate postpartum insertions of Lippes Loop D and Copper T IUDs and their counterpart Delta devices--an epidemiological analysis.

In this paper, an epidemiological analysis was performed, using an international data set, exclusively on the expulsion problem associated with postpartum IUD insertions. The inserter's experience in postplacental insertions is probably an important determining factor for IUD expulsions. Immediate insertions (within 10 minutes after placental delivery) are possibly associated with lower expulsion rates than later insertions (eg. two to 72 hours after placental delivery) during the woman's postpartum hospitalization. No significant differences were detected between the standard Lippes Loop D and Copper T IUDs and their counterpart Delta devices specifically designed for postpartum use, between the two types of Delta device or between the hand and inserter methods. A case-control analysis also did not detect any significant association between IUD expulsions and mild complications occurring or management performed during the third stage of labor and delivery. The practical implications of these findings, the methodologic problems of this analysis and future research strategies are also discussed.

Adult↗
PubMed2000

Intrapartum fever and unexplained seizures in term infants.

OBJECTIVE: Early-onset neonatal seizures are a strong predictor of later morbidity and mortality in term infants. Although an association of noninfectious intrapartum fever with neonatal seizures in term infants has been reported, it was based on only a small number of neonates with seizures. We therefore conducted a case control study to investigate this association further. METHODS: All term infants with neonatal seizures born at Brigham and Women's Hospital between 1989 and 1996 were identified. For this study, cases consisted of all term neonates with a confirmed diagnosis of seizure born after a trial of labor for whom no proximal cause of seizure could be identified. Infants with sepsis or meningitis were excluded. Four controls matched by parity and date of birth were identified for each case. The rate of intrapartum maternal temperature >100.4 degrees F was compared for case infants and controls. Potential confounding was controlled in logistic regression analysis. RESULTS: Cases comprised 38 term infants with unexplained seizures after a trial of labor. We identified 152 controls. Infants with seizures were more likely to be born to mothers who were febrile during labor (31.6% vs 9.2%). In almost all cases, the fever developed during labor (94.7% cases, 97.4% controls). At admission, mothers of infants with seizures were not significantly more likely to have factors associated with concern about infection such as a white blood cell count >15 000/mm(3) (28. 9% vs 19.1%) and premature rupture of the membranes (15.8% vs 17.8%). In a logistic regression analysis controlling for confounding factors, intrapartum fever was associated with a 3.4-fold increase in the risk of unexplained neonatal seizures (odds ratio = 3.4, 95% confidence interval = 1.03-10.9). CONCLUSION: Our data indicate that intrapartum fever, even when unlikely to be caused by infection, is associated with a fourfold increase in the risk of unexplained, early-onset seizures in term infants.

Adult↗
PubMed1998

[Analysis of 196 cases of trial of labor with borderline oligohydramnios assessed by ultrasound].

OBJECTIVE: To determine the effect of borderline oligohydramnios on perinatal outcome. METHOD: Patients admitted for delivery had an amniotic fluid index (AFI) assessment. Color Doppler was used to examine the systolic/diastolic ratio of the blood flow velocity in fetal umbilical arteries. Normal amniotic fluid volume was defined as an AFI of 8.1-18 cm (n = 200), and borderline oligohydramnios as 5.1-8.0 cm (n = 196). The two groups were compared on perinatal outcomes as all of the patients had trial of labor. RESULTS: There was no difference in the incidence of fetal distress and neonatal mortality between the two groups. The incidence of emergency section in borderline oligohydramnios group was significantly higher. CONCLUSION: The patients with borderline oligohydramnios may have a trial of labor under proper intensive care.

Female↗
PubMed2000

[Multivariate study of risk factors for arterial hypotension in pregnant patients at term undergoing Caesarean section under subarachnoid anesthesia].

OBJECTIVES: The most common and potentially dangerous complication of spinal anesthesia for cesarean section is arterial hypotension. The aim of this study was to analyze maternal and gestational factors that might affect risk of arterial hypotension in full-term parturients undergoing cesarean section. MATERIAL AND METHOD: We enrolled full-term parturients scheduled for elective cesarean section under spinal anesthesia. Spinal puncture was performed at L2-L3 using an atraumatic Sprotte-type needle. We administered 12.5 mg of hyperbaric 0.5% bupivacaine and 12.5 micrograms of fentanyl. Arterial hypotension was defined as a decrease in systolic pressure of at least 20% or a decrease to a pressure below 100 mmHg. Multivariate analysis was performed to identify factors related to the presentation of hypotension appearing in the interval between spinal puncture and birth. RESULTS: The incidence of arterial hypotension was 33.3%. Statistical analysis revealed that integrity of the amniotic sac, parity and elective cesarean were significantly associated with a higher incidence of arterial hypotension (p < 0.03). CONCLUSIONS: Identifying risk for multiparous parturients with intact amniotic sacs scheduled for elective cesarean can be worthwhile if greater preventive measures are taken in such patients to reduce the incidence and intensity of arterial hypotension.

Abdominal Pain↗
PubMed1991

Once a cesarean?

Explore the source record for details and available documents.

Cesarean Section↗
PubMed1990

Labor patterns in women with previous cesareans.

Little information exists to help determine the presence or significance of labor abnormalities in women attempting vaginal birth after previous cesarean. A case-control study was performed to obtain information on patterns of labor progress and the incidence of dysfunctional labor in patients having a trial of labor after previous cesarean delivery. Sixty-eight such women were matched to nulliparous and multiparous controls. Labor-curve characteristics for the group of women with previous cesarean differed significantly from those of both the nulliparas and multiparas. When stratified by history of previous vaginal birth, however, those with no previous vaginal birth were indistinguishable from nulliparous controls and those with a previous vaginal birth were indistinguishable from multiparous controls. Parity-specific criteria for the diagnosis of dysfunctional labor were thus indicated. Labor disorders were present most frequently in the previous-cesarean group with no previous vaginal birth (41.9%). This incidence did not differ significantly from that in the control nulliparas (27.1%) (P = .15), but did differ from that in the multiparas (15.8%) (P less than .01). Previous-cesarean patients with a previous vaginal birth had a frequency of labor disorders (14.3%) not significantly different from that of multiparous controls. We conclude that trial of labor in women with a previous cesarean should be evaluated by standard criteria for nulliparas if there has been no previous vaginal birth, and by criteria for multiparous women if there has been any previous infant born vaginally.

Adult↗
PubMed1990

[The Zavanelli maneuver: use during breech retention of the head in the birth canal. Apropos of a case].

A case is presented where Zavanelli's manoeuvre was carried out when the chin of the fetus was caught up above the symphysis pubis. This new concept for managing partially born infants that cannot be delivered vaginally, by Cesarean section improves greatly the prospect for survival of the fetus with minimal extra risk for the mother. It is easier to carry out the manoeuvre when the patient is under epidural analgesia.

Adult↗