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Results for “LABOR COMPLICATIONS”

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At least 1,387 records · Page 77Linked to original sources
PubMed1990

Safety and efficacy of combined ritodrine and magnesium sulfate for preterm labor: a method for reduction of complications.

Ritodrine hydrochloride and magnesium sulfate used in combination for preterm labor tocolysis have been cited for yielding excessively high complication rates. A retrospective chart review was performed to assess the frequency of these complications and to determine whether tocolysis can be continued despite complications. Of 95 patients managed with dual tocolytics, 61 had side effects sufficiently serious to warrant cessation of tocolytic therapy for an overall complication rate of 64%. After evaluation for objective evidence of pathologic conditions, 41 (67%) patients were restarted on dual tocolytics without further complication. It was deemed inappropriate to restart tocolysis in 20 patients, resulting in a 21% rate of complications. This allowed a significant increase in the number of patients delivering after 36 weeks (19.5% versus 50%, p less than 0.02) and a decrease in neonatal intensive care unit days per infant (3 versus 15.5 days, p less than 0.02). This suggests that aggressive continued tocolysis with multiple agents can be safe and efficacious with appropriate evaluation.

Adolescent↗
PubMed1991

Bleeding and the third stage of labor.

The third stage of labor often is scarcely considered by parturients and birth attendants although it is thought to be the most dangerous stage of labor because of the risk of significant hemorrhage. Safe clinical management based on respect and understanding of the anatomy and physiology of the third stage of labor may prevent many complications. Management of third stage labor is presented. Uterotonic agents and techniques for control of bleeding are discussed.

Clinical Protocols↗
PubMed1981

Pregnancy in thoracic scoliosis.

We present information about 118 pregnancies in 64 patients with thoracic scoliosis, two-thirds of whom had curves in excess of 60 degrees. Although increased breathlessness was experienced in 17% of pregnancies, no serious cardiorespiratory problems were encountered. Increased black pain occurred in 21% of pregnancies. Spontaneous vaginal delivery was achieved in 65% of pregnancies and caesarean section was performed in 17%. Operative delivery was almost invariably for purely obstetric indications. We conclude that even in severe thoracic scoliosis, pregnancy and labour are not associated with serious cardiorespiratory complications.

Female↗
PubMed2005

[The counselling of patient with prior C-section].

A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. Information and counselling aim to estimate specific risks and to balance these risks according to individual factors. Therefore, the physician has to answer two questions: (i) which would be the probability of successful vaginal delivery? (ii) which would be the risk of uterine rupture with a trial of labor? The risk factors for failure of trial of labor are: increased maternal age, obesity, and fetal macrosomia. The risk factors for uterine rupture are: increased maternal age, postpartum fever after the previous cesarean delivery, short interdelivery interval, history of at least two previous cesarean deliveries, and a history of classical incision. Conversely, other factors are of good prognosis: a prior vaginal delivery and, particularly, a prior VBAC (Vaginal Birth After Caesarean) are associated with a higher rate of successful trial of labor compared with patients with no prior vaginal delivery; ultrasonographic measurement of the lower uterine segment thickness>3.5 mm has an excellent negative predictive value for the risk of uterine defect. Finally, the wish for additional pregnancies following a cesarean section must be considered as an argument in favour of a trial of labor after accounting for the increasing risks correlated with repeated elective cesarean deliveries.

Adult↗
PubMed2006

Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.

OBJECTIVE: Assess effects of body mass index (BMI) on trial of labor after previous cesarean delivery and determine whether morbidly obese women have greater maternal and perinatal morbidity with trial of labor compared with elective repeat cesarean delivery. METHODS: Secondary analysis from a prospective observational study included all term singletons undergoing trial of labor after previous cesarean delivery. Body mass index groups were as follows: normal 18.5-24.9, overweight 25.0-29.9, obese 30.0-39.9, morbidly obese 40.0 kg/m2 or greater, and were compared for failure and maternal and neonatal morbidities. The morbidly obese trial of labor and elective repeat cesarean delivery were compared for maternal and neonatal morbidities. Multivariable logistic regression analysis controlled for confounding variables. RESULTS: There were 14,142 trial of labor participants and 14,304 elective repeat cesarean delivery participants. Increasing BMI was directly associated with failed trial of labor after previous cesarean delivery: from 15.2% in normal weight (1,344) to 39.3% in morbidly obese (1,638), with combined risk of rupture/dehiscence increasing from 0.9% to 2.1% in morbidly obese women. Among morbidly obese women, trial of labor carried greater than five-fold risk of uterine rupture/dehiscence (2.1% versus 0.4%), almost a two-fold increase in composite maternal morbidity (7.2% versus 3.8%) and five-fold risk of neonatal injury (1.1% versus 0.2%) (fractures, brachial plexus injuries, and lacerations), but no neonatal encephalopathy. Morbidly obese women failing a trial of labor had six-fold greater composite maternal morbidity than those undergoing a successful trial of labor (14.2% versus 2.6%). CONCLUSION: Body mass index correlates with outcomes in trial of labor after previous cesarean delivery. Morbidly obese women undergoing a trial of labor were at increased risk for failure. Increased BMI was associated with greater composite morbidity and neonatal injury compared with elective repeat cesarean delivery, but absolute morbidities were small. Increased risks should be considered before trial of labor after previous cesarean delivery. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed1996

Vaginal birth following unmonitored labor in patients with prior cesarean section.

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

Adult↗