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Cervicovaginal fistulas that develop after midtrimester abortion represent a significant risk to subsequent pregnancies. Since patients with this condition appear to be at increased risk for preterm labor and cervical incompetence, I recommend a cerclage procedure. The probability of complications during labor in such cases makes elective cesarean delivery the method of choice.
This case report describes the diagnosis, treatment as well as maternal and fetal outcome of a pregnancy complicated by peripartum cardiomyopathy (PPCM). The article demonstrates criteria that define peripartum cardiomyopathy using clinical and echocardiographic features. In absence of preexisting heart disease an acute left ventricular dysfunction of the mother led to fetal bradycardia and immediate delivery. We discuss possible causes, clinical management and long term outcome in respect of the available literature. Future pregnancies should be avoided with at least 50 % risk of recurrence.
Complications of delivery are dominated by the problem of obstetric hemorrhages. Minor complications are common, concerning about 20% of all labors, while serious complications are rare: of the order of 0.1%. Their peculiarity lies in their association with blood coagulation disturbances of multifactorial origin. Treatment requires close cooperation between the anesthesiologist/intensive care specialist and the obstetrician when management decisions are made. Trials of medical and obstetric measures should not lead to any delay when deciding that laparatomy is required to ensure hemostasis. Hesitation most often compromises the chances of success of conservative surgical treatment by selective ligations and forces hysterectomy.
During the last decade the rate of pregnancies in renal transplant recipients has been increasing. Now as before severe and unexpected complications can occur. After treatment with Dihydralazine in combination with Fenoterol we observed a drastic deterioration of kidney and heart function in one of our patients. Therefore such a drug combination does not seem to be recommendable for renal transplant recipients.
A comparison was made between 535 primiparae with a record of therapeutic termination of previous pregnancies, 305 primiparae with previous abortion, and 501 primiparae without any record of spontaneous or medically induced abortion, all of these being compared for their prepartum, intrapartum, and postpartum phases as well as the conditions of their children delivered in their first intrapartum, and postpartum phases as well as the conditions of their children delivered in their first full-term pregnancy.--Significant accumulation of spontaneous abortions, bleeding in the first and second thirds of pregnancy, as well as postpartum complications were recordable from women with record of induced or spontaneous abortions, in comparison with primigravid primiparae. All probands with record of previous termination of pregnancies exhibited a trend towards premature births, yet, with no significant accumulation of these. Significantly increased use of therapeutic and prophylactic measures, such as cerclage and tocolysis, should be taken into due consideration, in that context.
Plasma levels of dehydroepiandrosterone (DEA) and 17-hydroxyprogesterone (17-HP) were studied in 43 pregnant females 11 with normal pregnancy and labor and 32 at high risk of obstetric complications (primary powerless labor, prematurity, postmaturity, rapid parturition). Hormonal investigation was performed in each particular female in the time-course of her pregnancy and labor as well as in the mixed blood plasma from the umbilical cord. Concentrations of hormones observed in the females with normal pregnancies and labors differed from those in the patients whose pregnancy was complicated as well as their labor. It has been concluded that the results of DEA and 17-HP variation assessment in the blood plasma are essential additional indicators of adrenal performance both in mother and fetus.
OBJECTIVE: To determine the extent of maternal morbidity associated with in utero transfer. DESIGN: Retrospective study of 190 consecutive cases over two years. SETTING: Liverpool Maternity Hospital. PATIENTS: 190 Pregnant women were transferred to the hospital under the in utero transfer arrangements from district general hospitals both within and outside the Mersey region. The women admitted were divided into two categories: those in threatened or established uncomplicated preterm labour and those who may or may not have been in threatened or established preterm labour but who had coexisting complicating factors affecting the mother or fetus, or both. INTERVENTIONS: Planned delivery of the fetus if indicated and arrangements for appropriate postpartum care of the mother. MAIN OUTCOME MEASURE: Assessment of the progress of labour and, if appropriate, resuscitation of the mother. RESULTS: Women who were transferred with no coexisting disease (124) had relatively uncomplicated deliveries whereas those transferred with coexisting diseases (66) exhibited considerable morbidity and 17 of these required prolonged intensive monitoring after delivery. CONCLUSIONS: In utero transfer in healthy mothers may have benefits for babies born very prematurely. If mothers have coexisting disease, however, the desirability of transfer should be reviewed urgently in the light of the considerable maternal morbidity associated with these problems. In these cases transfer may introduce an additional hazard.
Fetomaternal bleeding in pregnancy is the most common cause of rhesus immunization. In this study we evaluated the amount of fetomaternal bleeding during pregnancies with and without complications. The data from 1204 patients are analyzed. Fetomaternal bleeding was of clinical relevance (HbF greater than 0.01%) in 6% of all uncomplicated pregnancies. There was no increased fetomaternal bleeding in pregnancies complicated by gestosis, preliminary labour, placenta praevia, trauma, and diabetes in pregnancy. In cases with premature rupture of the amnion or vaginal bleeding in pregnancy we observed an increased percentage of fetomaternal bleeding into the mother's circulation. Nearly 25% of all patients with hydrops fetalis had clinical relevant fetomaternal bleeding (HbF greater than 0.01%).
Information now available on method of delivery from birth certificates confirms past findings on the groups at highest risk of cesarean delivery and greatly expands our knowledge of the demographic and health characteristics associated with cesarean delivery. Mothers who live in the South, who are in the oldest years of childbearing, having their first birth, married, or who have high educational attainment are all at increased risk of a cesarean delivery. Very short gestations, low or high birthweights, multiple delivery, the presence of certain complications of pregnancy, labor and/or delivery, abnormal conditions of the newborn, and the use of some obstetric procedures are also associated with elevated cesarean rates. Several recent studies (28,29) have concluded that advanced maternal age in and of itself may be an independent risk factor for cesarean delivery, due to physician and patient concern over pregnancy outcome for older women. Many of the characteristics examined in this study are highly related to maternal age (for example, marital status and educational attainment). Therefore, for these variables, mother's age is also taken into account to determine if age itself is the underlying reason for differences in rates of cesarean delivery. The importance of the role of maternal age in the risk of cesarean delivery is clearly demonstrated throughout this report: Older mothers are more likely to deliver by cesarean regardless of race, Hispanic origin, parity, marital status, or educational attainment. The overall rate of cesarean delivery is only slightly lower for black than for white mothers (22.1 percent compared with 23.0 percent), despite the generally lower educational attainment of black mothers and the higher percentage who are unmarried or in their teen years, all factors that tend to substantially lower the risk of cesarean delivery. However, there are many offsetting factors that tend to raise the cesarean rate for black mothers. A relatively high proportion of black births occur in the South, which has the highest cesarean rate of all regions; the incidence of low and very low birthweight is far higher for black births; and premature delivery is twice as frequent for black babies. Also, although rates of cesarean delivery for most medical risk factors, complications of labor and or delivery, and abnormal conditions of the infant are about the same for both races, the incidence of a number of these conditions is substantially higher for black mothers and babies, and that has the effect of increasing the overall cesarean rate for black mothers.(ABSTRACT TRUNCATED AT 400 WORDS)
Variable decelerations during the last 2 hours of labor were associated with an abnormally positioned umbilical cord at delivery in 52% of cases. In cases where an abnormally positioned umbilical cord was seen at delivery, 89% had been preceded by variable decelerations. Cord compression resulted in an A-V difference in pH that was significantly increased when compared to a control group. This was mainly due to a decrease in the pH of the umbilical artery. The pathophysiology of cord compression is discussed.
INTRODUCTION: Emergency department deliveries are uncommon in the Singapore setting, but when they do occur, the emergency physician has to be able to deliver the child safely, perform neonatal resuscitation if needed, and try to prevent any birth trauma to the child or complications of delivery in the mother. We present our experience of emergency room deliveries spanning 7 years in a community hospital without obstetric or neonatal backup. MATERIALS AND METHODS: This is a retrospective case series. A search was made through our electronic medical records system for patients presenting in labour or with deliveries from March 1997 to October 2004. They were studied for demographic and social factors, gravidity and parity, as well as any complications (during birth and in the immediate post-delivery period) in both parent and child. RESULTS: Twenty-three patients presented to our emergency department with labour contractions, and 14 progressed to vaginal deliveries. Twelve were single mothers who had hidden their pregnancies, while another 2 married patients had unsuspected pregnancies. No neonate needed resuscitation or airway support, but there were 4 patients without episiotomy who sustained perineal tears, and another 2 patients in whom the placenta could not be delivered. A child (born to a single mother without antenatal care) had a low Apgar score, but improved with oxygen and suctioning. CONCLUSIONS: An emergency department in a non-obstetric hospital should have in place adequate preparations to cater for the occasional unexpected emergency delivery and the associated need for neonatal resuscitation. In our series, there was a high proportion of concealed (hidden) and "unaware" pregnancies presenting in labour. Prompt referral to a maternity hospital with neonatal care should be made for any complications.
OBJECTIVE: The aim of this study of transverse lie in labor of patients admitted to Korle Bu Hospital between 1 January 1996 and 30 June 1998, was to identify the methods of delivery, the perinatal and maternal morbidities and mortalities, and to provide recommendations to improve the outcome. METHODS: This was a retrospective study of 152 patients who presented at the labor wards with transverse lie. The data sources of this study were the antenatal records, the labor wards delivery record books, the postnatal records and the admission books at the Neonatal Intensive Care Unit. RESULTS: One hundred and forty-two cases (92.1%) had an emergency cesarean section. The rest had the external version followed by vaginal delivery. There were two maternal deaths resulting from hemorrhage, infections and difficult surgery. There were 25 stillbirths, and 37 of the neonates required hospital admission. CONCLUSION: Transverse lie carries a high rate of complications in labor. Delivery should be carried out without delay in a hospital well-equipped for cesarean delivery and assisted vaginal delivery. The complications could be further reduced by early diagnosis during the antenatal period when associated risk factors, such as placenta previa could be diagnosed with the aid of the ultrasound scan. Elective deliveries could then be undertaken.
Women's degree of participation, satisfaction, and change in health locus of control after giving birth in an alternative birthing unit was examined. A quasiexperimental two-group design of convenience samples (N = 99) was used to compare differences and evaluate the care given. An alternative birthing experience increased women's sense of participation and related to women's satisfaction, but did not change internal scores on the Multidimensional Health Locus of Control Scales. Women's reliance on powerful others increased post delivery. Complications were negatively related to selected aspects of women's satisfaction in labor and delivery, but positively related to satisfaction with antepartal care.
In this case report a 27-year-old parturient with a previous caesarean section was diagnosed as having had a uterine rupture in labour. The diagnosis was based on the sonographic demonstration of considerable amounts of free fluid in the abdomen 2 h postpartum, and confirmed by finding fetal skin cells in this fluid. There was no hemorrhage and the fluid disappeared overnight. She was managed expectantly and made a rapid and full recovery.
Seizure activity in the immediate neonatal period has been shown to correlate with long-term neurological handicap. The perinatal course of 34 term and 32 preterm infants who developed seizure activity in the neonatal period was compared to that of 66 matched control infants without neonatal seizure activity. The incidence of antenatal complications and abnormal fetal heart rate patterns and the percentages of abnormal labor, operative delivery, and low Apgar scores were significantly greater in the study infants than in the control infants. Earlier onset of seizure activity was seen in term versus preterm infants and term infants with abnormal versus normal fetal heart rate patterns. Management decisions regarding intervention or nonintervention based on fetal heart rate patterns were deemed appropriate in 31 of 34 term infants, yet short- and long-term neurological sequelae were significant.
This case report concerns a late pregnancy complication, clinically apparent as severe variable decelerations in the first stage of labor. Emergency cesarean section delivered a mildly asphyxiated full-term newborn infant. Examination of the umbilical cord revealed a thrombus of the right umbilical artery, near the fetal side, confirmed by histological examination. The total length of the umbilical cord, only 30 cm, was below the limit necessary for uncomplicated delivery of the fetus near term. Transient stretching during fetal descent is thought to be responsible for constriction of the umbilical arteries, blood flow sludging and thrombosis. Although only a few cases have been reported, thrombosis of the umbilical vessels has to be considered whenever the fetal heart rate pattern shows unexplained variable decelerations.
OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of dilation and evacuation versus misoprostol induction of labor for second-trimester termination. STUDY DESIGN: Using decision analysis, we compared the cost-effectiveness of dilation and evacuation and misoprostol induction of labor for second-trimester termination. Complications for dilation and evacuation and induction of labor included repeat dilation and curettage, cervical laceration repair, hospital admission, laparotomy, hysterectomy, and maternal death. Induction of labor complications also included failed induction of labor. The primary outcome was cost per quality-adjusted life year. Sensitivity analyses were performed for all relevant variables. RESULTS: Dilation and evacuation was less costly and more effective than misoprostol induction of labor for second-trimester termination with baseline estimates. In 1-way sensitivity analysis, the model was robust to all variation in probabilities and costs. In Monte Carlo simulation with 1000 trials and a cost-effectiveness threshold of $50,000/quality-adjusted life year, dilation and evacuation was the preferred approach in 97.9% of trials. CONCLUSION: Dilation and evacuation is less expensive and more effective than misoprostol induction of labor for second-trimester termination.
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