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At least 145 records · Page 8Linked to original sources
PubMed2006

Obstetric and neonatal outcomes in women who live in an urban resettlement area of Delhi, India: a cohort study.

AIM: To study the pregnancy outcome, namely mode and place of delivery, attendant at birth and perinatal mortality in an urban resettlement area of Delhi, India, and to determine factors that affect the outcome. METHODS: All the pregnant women (n = 909) in the area were enrolled and followed until 7 days after delivery. We calculated the crude and adjusted odds ratios for predictors of pregnancy related obstetric and neonatal outcomes, using logistic regression analysis. RESULTS: A total of 884 (97.3%) women could be followed up. Approximately two-thirds of deliveries took place at home. Primigravida, more educated mothers and mothers with non-cephalic presentation or complications were more likely to deliver in a health facility (P < 0.05). Most deliveries (97%) were vaginal, 2.5% were cesarean and 0.5% forceps deliveries. Primigravida mothers, mothers with short stature, mothers with non-cephalic presentation or complications had cesarean and forceps delivery more often (P < 0.05). A perinatal mortality rate of 74.5 per 1000 live births was observed. Presentation of the fetus and complications in the mother remained important factors. CONCLUSION: The majority of deliveries in the under-privileged sections in urban Delhi take place at home and the perinatal mortality remains high.

Adolescent↗
PubMed1998

Is there an incremental rise in the risk of obstetric intervention with increasing maternal age?

OBJECTIVE: To determine whether increasing maternal age increases the risk of operative delivery and to investigate whether such a trend is due to fetal or maternal factors. DESIGN ANALYSIS: of prospectively collected data on a maternity unit database. SETTING: A postgraduate teaching hospital. POPULATION: 6410 nulliparous women with singleton cephalic pregnancies delivering at term (3742 weeks of gestation) between 1 January 92 and 31 December 95. MAIN OUTCOME MEASURES: Mode of delivery, rates of prelabour caesarean section, induction of labour and epidural usage. RESULTS: There was a positive, highly significant association between increasing maternal age and obstetric intervention. Prelabour (P < 0.001) and emergency (P < 0.001) caesarean section, instrumental vaginal delivery (spontaneous labour P < 0001; induced labour P = 0.001), induction of labour (P < 0.001) and epidural usage in spontaneous labour (P = 0.005) all increased with increasing age. In the second stage of labour fetal distress and failure to advance, requiring instrumental delivery, were both more likely with increasing maternal age (in both P < 0.001). Epidural usage in induced labour and the incidence of small for gestational age newborns did not increase with increasing maternal age (P = 0.68 and P = 0.50, respectively). CONCLUSIONS: This study demonstrates that increasing maternal age is associated with an incremental increase in obstetric intervention. Previous studies have demonstrated a significant effect in women older than 35 years of age, but these data show changes on a continuum from teenage years. This finding may reflect a progressive, age-related deterioration in myometrial function.

Adolescent↗
PubMed1998

Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial.

OBJECTIVE: To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries. DESIGN: A randomised controlled trial. SETTING: The delivery suite at Leeds General Infirmary. SAMPLE: One hundred and thirty-five nulliparous women with an effective epidural in labour. METHODS: The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner. MAIN OUTCOME MEASURE: Rate of instrumental vaginal delivery. RESULTS: There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31, 95% CI 0.62-2.78). No adverse effects were noted. CONCLUSION: Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.

Adult↗
PubMed1999

Subsequent obstetric performance related to primary mode of delivery.

OBJECTIVE: To relate subsequent obstetric performance with primary mode of delivery. DESIGN: Postal questionnaire survey of women who delivered their first child five years ago. SETTING: Huddersfield Royal Infirmary. POPULATION: Women who were delivered of their first baby in 1991: 250 by normal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caesarean section. MAIN OUTCOME MEASURES: Answers to fixed choice questions on fear of future childbirth, number of subsequent children and reasons for no further children. RESULTS: The response rate was 64%. Overall, 222 (46.6%) women were initially frightened about future childbirth. According to mode of delivery: 93 (57.1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delivery, 99 women (20.8%) were still frightened about future childbirth: instrumental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and normal vaginal group 15 (10.1%). In the group of women who were delivered by caesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((P < 0.03, relative risk 1.46 (1.07-1.99)). In the group of women who had a vaginal instrumental delivery 6% more had not had a second child after five years compared with normal vaginal delivery group. Of the women who had no further children, 30% who had caesarean section and 28% vaginal instrumental delivery had involuntary infertility. CONCLUSIONS: Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and to some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.

Adolescent↗
PubMed1978

Compound presentation following external version.

Two cases of compound presentation following external version are presented. The frequent combination of the feet with the vertex following this procedure and its association with a higher fetal mortality, interference rate, and obstructed labour than the hand and vertex combination are highlighted. The aetiology, problems in diagnosis, and management are discussed. Measured to prevent and deal with this complication are suggested.

Adolescent↗
PubMed1987

Vaginal delivery after 3 previous caesarean sections.

A patient who had had 3 previous Caesarean sections was permitted a trial of scar in her subsequent confinement. Labour occurred spontaneously at 39 weeks, and was closely monitored. After an uneventful labour of 3 1/2 hours, a Wrigley forceps lift-out was performed. There was no maternal or neonatal morbidity and the uterine scar was intact.

Adult↗
PubMed1993

A comparison of abdominal and vaginal examinations for the diagnosis of engagement of the fetal head.

The diagnosis of engagement of the fetal head is mandatory before operative vaginal delivery is to be attempted. There is widespread belief that the fetal head is engaged in the maternal pelvis when vaginal examination reveals that the bony presenting part has reached the level of the ischial spines. However, it is also claimed that in the presence of moulding the vaginal findings may be misleading and that it may be preferable to make the diagnosis by abdominal examination of the level of the fetal head in relation to the pelvic brim. In order to evaluate the relative merits of each of these 2 systems of physical examination, a retrospective study was made of 104 cases which had been evaluated for possible operative vaginal delivery by both methods. Prediction of successful vaginal delivery was greater by abdominal criteria (94%) than by vaginal criteria (80%) (p < 0.01). When evaluated by maximum likelihood logistic regression analyses, the factor of greatest importance in determining the probability of allocation of a case to each of the engagement groups was moulding (odds ratio 2.17; 95% confidence intervals 0.75-6.27). We conclude that when these 2 methods of assessment produce different diagnoses, the major factor responsible is moulding of the fetal head. Clinical evaluation prior to operative vaginal delivery must include abdominal examination and reliance on vaginal findings alone may prove misleading when moulding is present.

Adult↗
PubMed1998

Repeat instrumental delivery: how high is the risk?

The objective of this study was to investigate whether a history of previous instrumental delivery imposes a higher risk of operative delivery in subsequent pregnancies. The outcome of labour in 108 women with 1 previous instrumental delivery was compared to that of 216 randomly-selected controls delivered in the same period. There was no difference between these 2 groups of patients in maternal age, height, parity, gestational age, incidence of induction of labour, incidence of epidural analgesia, or birth-weight of the babies. The incidence of instrumental delivery was found to be 8.3% among the study group, which was significantly higher than that of 2.3% among the control cases (relative risk = 3.6, 95% CI 1.24 to 10.5). This increase in risk of operative delivery was independent to the indications for or the type of instrumental delivery in previous pregnancies. We conclude that women with 1 previous instrumental delivery are at a higher risk of repeat operative delivery. This may have implication in assessing patients for home delivery.

Birth Weight↗
PubMed1998

Spontaneous abortion: short-term complications following either conservative or surgical management.

Spontaneous abortion is a common gynaecological condition. It is a commonly held belief that medical morbidity associated with this condition is low and that routine treatment should be surgical evacuation of the uterus. This study was performed to study the short-term complications of spontaneous abortion and its management. Transvaginal sonography (TVS) was used to determine whether retained products of conception (POCs) were visible inside the uterus in women presenting with spontaneous abortion. If tissue was present, surgical evacuation of retained products of conception (ERPC) was performed. If the uterus was empty, the patients were managed expectantly. Four hundred and seventy women were treated with ERPC and 297 were managed expectantly. The complication rate was 3.0% in those managed expectantly compared with 5.8% for those treated by ERPC. Subjects with no POCs on TVS can therefore be managed expectantly without increasing the risk of morbidity associated with this condition.

Abortion, Incomplete↗