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PubMed1979

[Results and consequences using Prechtl's concept of optimal conditions. Obstetrical and Postnatal complications (author's transl)].

An extended list of Prechtl's list of optimal obstetric conditions was used to describe the history of 200 newborns, randomly chosen from a defined population born in 1972. Differences between the population from Groningen (Prechtl's) and Tübingen, and different definitions of the items used in the list are discussed. Reduced optimal conditions in the history of the mother effectively reduced the optimal conditions in the newborn aswell. This was particularly so in case of: Preterm deliveries and miscarriages, bleedings in the first trimester, preterm onset of labour, operative deliveries, less than 38 weeks of gestational age, and an Apgar score below 7.

Abortion, Spontaneous↗
PubMedDate not supplied

[Perinatal medical possibilities and limitations of the obstetrical center--an analysis of the causes of perinatal mortality 1982-1985].

Based on the analysis of 4,881 deliveries during 1982-1985 the perinatal statistical data of a regional perinatal center (level 3) are presented. There is high percentage of pregnancies at risk (57%), preterm deliveries (11%), and increasing incidence of multiple pregnancies (3%). The rate of spontaneous deliveries amounts to more than 70%, the frequency of cesarean sections reached a maximum of 19%. As causes of 82 perinatal deaths (16.8% mortality rate) were found above all fetal malformations (42%), multiple pregnancy (18%), severe intrauterine growth retardation (17%), and premature rupture of membranes with septic complications (10%). Further causes of perinatal death were severe umbilical cord complications (5%), diabetic pregnancy (5%), abruptio placentae and maternal high risks. After detailed analysis 55% of all perinatal deaths proved to be unavoidable, 18% possibly avoidable, and 27% avoidable. The presentation of the avoidable perinatal deaths demonstrates the shortcomings and possible improvements of the obstetrical management and organization. The possibly avoidable cases could be solved in future. According to the purged perinatal mortality rate there are 4 remaining avoidable cases for which the perinatal center proved to be responsible. The perinatal mortality risk in the regional center is therefore less than 1%o.

Congenital Abnormalities↗
PubMed1989

Grand multipara.

Grand multiparity is often considered a clinical entity, as certain complications during pregnancy, delivery and puerperium are thought to occur with increased incidence in these women. In this prospective investigation no difference in complications was found between women with up to 6 deliveries and women with 7 or more deliveries. However the incidence of preterm deliveries was significantly higher in the group with up to 6 deliveries.

Adult↗
PubMed1976

A study of complications in preterm deliveries after prolonged premature rupture of the membranes.

The risk of infection for mother and baby after spontaneous rupture of the membranes was evaluated in a prospective study of 24 patients with ruptured membranes before the 36th week of pregnancy. The mean length of pregnancy after rupture was 10 days and 2 hours. Only patients harboring Group B streptococci or E. coli in the urogenital tract were treated with antibiotics (during delivery). With the exception of 1 woman, all patients harbored one or more pathogens in the urogenital tract. Four mothers were infected but all recovered. One of 26 infants died from infection. The study did not confirm any association between prolonged rupture of the membranes and the frequency of idiopathic respiratory distress syndrome, nor did it contradict attempts to actively prolong pregnancy after rupture of the membranes.

Bacterial Infections↗
PubMed2006

[Obstetrical results in women who underwent intrauterine invasive procedures during the pregnancy].

OBJECTIVE: The aim of this study was retrospective analysis of the results of pregnancies among women who had intrauterine invasive procedures (IIP)--amnioinfusion, amnioreduction, cordocentesis and shunts, based on the materials from Polish Mother's Memorial Hospital Research Institute in 2000-2003. MATERIAL AND METHODS: 320 women performed IIP: amnioinfusions due to the oligohydramnion (frequently connected with congenital fetal abnormalities) or premature rupture of membranes. Amnioreduction due to the polihydramnion (also in a twin pregnancy with TTTS syndrome). Implantation of shunts in fetal abnormalities--hydrocephalus, megabladder, CALM. Cordocentesis--diagnostic or therapeutic in a fetal immunisatio anty-Rh factor and fetal arrhythmias. RESULTS: The total percentage of pregnancy failure after IIP was 53.2%. The best results were in the groups with hydrocephalus and immunisatio anty Rh factor, the worst in the group of patients with severe oligohydramnion due to the congenital abnormalities of fetuses' kidney. The most frequent early complications after IIP were premature rupture of membranes (12.2%), fetal hypoxia (13.7%) and premature constrictions of uterus (8.4%). 21.3% of patients delivered in less than 5 days after IIP ( delivery or abortion) due to the early complications or after resolving the obstetrical situation, e.g. the genetic reason of fetal abnormalities or lethal abnormalities. More complications were connected with amnioinfusion than with amnioreduction. Cordocentesis seemed not to be connected with more often appearing of fetal hypoxia. CONCLUSION: (1) IIP are connected with a big percentage of pregnancy failure, but it is more a result of fetal serious disease than a intrauterine procedure. (2) Performing an amnioinfusion or cordocentesis in severe oligohydramnion gives a quick diagnosis of fetal potential abnormalities and makes it possible to outlook the fetal prognosis. (3) Patients should be as early as possible qualificated to IIP to avoid complications caused by the primary fetal disease. (4) Patients for IIP should be carefully selected and prepared. They need very strict observation for a fetal well-being and monitoring the infective factors after the procedure.

Female↗
PubMed1985

Obstetric consultations during labor and delivery in a university-based family practice.

This study retrospectively examined the use of obstetrical consultants by family medicine residents and faculty at the University of Washington Hospital from July 1, 1980, to June 30, 1981. Of 125 deliveries, 104 (83 percent) were vaginal deliveries, 99 percent of which were performed by the family physician involved. There were 21 (17 percent) cesarean sections. Before the audit began, 13 complications of labor and delivery were established as criteria suggesting the need for consultation. Medical records were retrospectively examined for complications meeting these criteria. Formal consultations occurred in 32 percent of all deliveries. Of the patients with at least one of the 13 complications, 75 percent had consultations obtained. Patients with these complications had intrapartum risk scores that were significantly higher than patients without the listed complications. Apgar scores at 1 and 5 minutes were significantly lower in the group of patients meeting the consultation criteria (7.0 vs 8.0 at 1 minute; 8.3 vs 9.0 at 5 minutes). The criteria successfully identified a group of high-risk patients and could be an appropriate guide for decision making in the specific setting studied. Patients without one of the predetermined complications had a low rate of surgical intervention (cesarean section or midforceps deliveries); the negative predictive value was 98 percent.

Adult↗
PubMed1989

[The obstetric risk in adolescent primiparous females].

The obstetric risks in primiparae between 12 and 17 years of age have been reviewed in cases treated at our hospital from 1982 to 1987. We looked for intrauterine foetal deaths, premature deliveries (birth weight less than 2500 g), breech presentations, preeclampsia, Caesarean sectio rate, forceps rate, and thirdstage complications. The risks found in the group of 476 young primiparae were compared to those amongst the 26,768 overall deliveries during the same period. The incidence of breech presentations, preterm deliveries and forceps deliveries was about the same as in the general group. Intrauterine foetal death, thirdstage complications, Caesarean section deliveries, and, especially preeclampsia, were (markedly) less common than in the overall group. As a result, we no longer consider youthful mothers from our area a higher obstetric risk.

Adolescent↗
PubMed1988

Trial of scar.

It is becoming increasingly common to attempt vaginal delivery in women whose previous delivery or deliveries have been by caesarean section. The outcome in these "trials of scar" is generally good, with reported vaginal delivery rates ranging from 60% to 94% and few complications.

Cesarean Section↗
PubMed1988

Nongenetic implications of childbearing after age thirty-five.

A comprehensive review of the effects of advanced maternal age on nongenetic aspects of delayed childbearing is presented. Implications for fertility are assessed. Antepartum complications including hypertension, diabetes, placental abnormalities, and maternal mortality are reviewed. Labor patterns and neonatal outcome are evaluated with respect to age and parity. Recent well-controlled studies using multivariate regression analysis show that prenatal diagnosis, recognition, and management of high-risk pregnancy, antenatal and intrapartum fetal monitoring, and advances in perinatal medicine have dramatically reduced the problems associated with age. A management plan is presented.

Adult↗
PubMed1984

Pneumomediastinum in pregnancy: two case reports and a review of the literature, pathophysiology, and management.

Pneumomediastinum, free air trapped in the mediastinal connective tissue, is a rare complication of pregnancy, occurring most frequently in the second stage of labor. Symptoms are often not noted until after delivery. Occurrence before and in the first stage of labor, as seen in the two cases reported here, is more uncommon. One case history is the first report of the coexistence of pneumomediastinum and pneumothorax in pregnancy. The prognosis for spontaneous pneumomediastinum in pregnancy is favorable. Pathophysiologic mechanisms, diagnosis, and management are discussed, and a review of the literature is presented.

Adult↗
PubMed2003

[Pregnancy duration and mode of delivery in patients with cardiac insufficiency on the material of Jagiellonian University OB/GYN Clinic in the years between 1986-1999].

OBJECTIVES: Recent progress in cardiology and cardiac surgery lead many patients with cardiac disease in the procreative age. DESIGN: To asses the influence of cardiac disease on pregnancy and delivery. MATERIAL AND METHODS: 232 subjects with congenital and acquired cardiac anomalies, hospitalized in the Jagiellonian University OB/GYN Clinic between 1986-1999. Patients were divided according to NYHA classification depending on kind and grade of cardiovascular insufficiency. Acquired data were compared with data in the control group consisted of 424 subjects without any complications during pregnancy and delivery. RESULTS: We proved shortening of the pregnancy duration in more advanced NYHA classes. Percentage shave of preterm deliveries in 3rd and 4th class was 31.15%, what equals to 3 times preterm delivery rate in the control group. Preterm delivery rate in groups of NYHA I and II was similar to the rate in the control group. Acquired data reveal extremely high cesarean section rate in the material of patients with cardiac anomalies. Cesarean section rate in the group of NYHA I and II was 3 times higher (30%) than in control group (rate of 10%). NYHA III and IV groups has a cesarean section rate of 93%. Vaginal delivery rate in the NYHA I and II groups equals to 58.5%, what is 10 times higher than in NYHA III and IV groups (equals to 6.6%). CONCLUSIONS: 1. Pregnancy duration depends on cardiovascular sufficiency and is significantly shorten in NYHA III and IV groups. 2. Extremely high cesarean section rate in the analyzed group is due to decreased cardiac sufficiency.

Case-Control Studies↗