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At least 1,459 records · Page 81Linked to original sources
PubMed1994

Persistent occiput posterior presentation--a clinical problem.

In order to find out how often labor is complicated by persistent occiput posterior position, (OPP), and how it affects the course and outcome of labor, the records of 3648 deliveries were reviewed, a frequency of 4.7% was found. Also, the amount of operative deliveries was surprisingly high, less than half of these cases were delivered without operative intervention. Total duration of labor, stage II of labor were both significantly longer in the OPP group. The children in the OPP group also were significantly heavier (79 g) than the average birthweight in the whole material.

Birth Weight↗
PubMedDate not supplied

[New aspects of echography using during delivery].

The paper presents some aspects of the use of echography in obstetrics for the prediction and early diagnosis of labour abnormalities just before delivery and its first period. Prediction and early diagnosis of the nature of labour are made on the studies of changes in the myometrial thickness in the first period of delivery and myometrial echo structural features before and during delivery. Proceeding from the findings, labour abnormalities were corrected and the efficiency of drug therapy was evaluated.

Delivery, Obstetric↗
PubMed2001

Explosion of a vulvar hematoma during spontaneous vaginal delivery. A case report.

BACKGROUND: Vulvar hematoma formation during a spontaneous vaginal birth is rare. Although conservative management or observation is an option, complications, including delivery obstruction and excessive vaginal bleeding, may occur. CASE: A woman presented in active labor with an enlarging vulvar hematoma reaching the size of a softball. Spontaneous vaginal delivery occurred with an "explosion" of the hematoma and excessive blood loss. To obtain hemostasis, the hematoma cavity was explored and the bleeding points sutured. CONCLUSION: With a large intrapartum vulvar hematoma, the risk of rupture exists. If it occurs, delivery should be accomplished expediently, hemostasis achieved rapidly and blood loss monitored closely.

Adult↗
PubMed2001

[Pregnancy, delivery and perinatal outcome in adolescent pregnancy].

Retrospectively 398 adolescent primiparas have been analyzed in respect of the process of pregnancy, antenatal complications, mode of delivery and perinatal outcome. The researched contingent was divided into 2 age groups--up to 15 years and between 16-18 years. The results obtained were compared to a control group of 398 primiparas at the age of 20-24 years. The results indicate that the process of adolescent pregnancy is related to a substantially higher relative share of some complications like anemia, premature rupture of the membranes and preeclampsia. The frequency of pre-term labor has essentially increased. A basic model of birth-giving is the vaginal delivery, and the duration of delivery of the adolescent does not differ from that of the adult primiparas. There is not a significant difference between the adolescent and the adult pregnant in the placental and in the early puerperal period. An increased frequency of the fetal retardation is missing at the adolescent pregnancy.

Adolescent↗
PubMed2005

Cocaine use during pregnancy and the failure of vaginal birth after cesarean.

OBJECTIVE: To evaluate the failure rate of a trial of vaginal birth in women with singleton pregnancies and 1 prior cesarean section who reported using cocaine during the current pregnancy. STUDY DESIGN: The medical records of 9254 women who attempted a vaginal birth after cesarean (VBAC) at 16 community and tertiary care hospitals were retrospectively reviewed. VBAC was considered a failure if a woman who was initially considered suited to a trial of VBAC for whatever reason did not succeed in vaginal delivery and had to undergo a repeat cesarean section. We used stratified analysis as well as forward and backward logistic regression analysis to assess the relation between cocaine use during pregnancy and VBAC failure. RESULTS: Thirteen percent of patients who reported using cocaine had a significant 59% decrease in the odds for VBAC failure in the unadjusted analysis (OR = 0.41, 95% CI= 0.29-0.58) as compared to those who did not report using this substance. Nevertheless, after adjusting for other important predictors of failure and possible confounding variables, the use of cocaine in our final model showed no difference in the odds for VBAC failure (OR = 0.74, 95% CI = 0.49-1.13) as compared to the odds in women who did not report using the drug. CONCLUSION: We could not find any statistically significant difference in the odds for VBAC failure between patients who reported cocaine use during pregnancy and patients who reported those who did not.

Adult↗
PubMed1991

[Scarred uterus. Results and selection of patients for vaginal delivery. Apropos of 884 cases].

The authors present their results as far as successful vaginal delivery (in 39.9% of cases) carried out in 884 cases with a scar in the uterus. They also give the morbidity and maternal and fetal mortality as well as those that developed a rupture of the uterus. No mother died in their series and there was no fetal death that could be ascribed to a complete rupture or a uterine dehiscence. Both fetal and maternal mortality was considerably higher when the trial of scar failed or when a Caesarean section was carried out prophylactically, as compared with the results from vaginal delivery. 2.17% of all the 884 patients with a uterine scar had a complete or incomplete rupture of the scar. Finally the describe their criteria for selecting patients for attempts at vaginal delivery and they show that it is necessary to test the ability of the fetus to pass through the pelvis after looking very carefully at the partogram made for the previous Caesarean operation. In this way they were able to use a trial of labour in slightly contracted pelves or where the fetus was big in such a manner as to obtain a vaginal delivery in, respectively, 68 and 72% of cases.

Birth Weight↗
PubMed1991

X-ray pelvimetry-reappraisal.

Antenatal erect lateral X-ray pelvimetry was performed for 116 primigravidas and 53 multigravidas because of suspected cephalopelvic disproportion (CPD). Multigravidas were further subgrouped into 4 gravidas and greater than 4 gravidas. In the primigravidas, there was no statistical difference in the mean value of the anteroposterior diameter of the pelvic inlet (APD) of the elective (10.4 cm, +/- 0.6 SD) and the emergency (10.5 cm, +/- 0.9 SD) caesarean section group. In the multigravidas, the mean value of the APD showed a statistically significant decrease with increased parity. In this group, the chances of delivery by caesarean section were 74%, when the APD was less than 10.5 cm, and 12% if the APD was greater than 11.5 cm. It is concluded that cephalopelvic disproportion in primigravidas should only be diagnosed after adequate trial of labour with adequate uterine contractions. In multiparous patients, especially grand multiparas, X-ray pelvimetry is recommended in cases of suspected CPD before a trial of vaginal delivery is conducted, since the mode of delivery seems to depend primarily on the pelvic capacity.

Birth Weight↗
PubMed1988

Ultrasound diagnosis of defects in the scarred lower uterine segment during pregnancy.

A prospective study was begun using ultrasound to diagnose defects in the lower uterine segment. Seventy patients were examined and delivered by cesarean section, including 58 at risk because of previous cesarean section and 12 nulliparous controls not at risk. Of the at-risk patients, 12 had confirmed defects, for an incidence of 20.7%. All the controls were normal. The false-positive rate for at-risk patients was 7.1%, and the positive and negative predictive values were 92.3 and 100%, respectively. For the diagnosed cases, the sonographic lower uterine segment seemed to form earlier (P less than .01) and was thinner (P less than .01) than that in the negative cases or the controls. Although our study design was observational and did not allow us to test the performance of the lower uterine segment when a defect was found, we discuss the use of a three-stage classification system to assist in identifying sonographically detected defects in a future trial of labor protocol. We conclude that sonographic surveillance is a reliable and practical means of evaluating the lower uterine segment after conception and before labor or delivery.

Cesarean Section↗
PubMed1997

[Echographic measurement of the inferior uterine segment for assessing the risk of uterine rupture].

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous cesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labor. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labor in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous cesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 uterine ruptures and 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 patients with values of 3.6-4.5 mm, 14 (10%) among 136 patients with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly correlated to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective cesarean is the standard procedure to offer a trial of labor to patients with a thickness value of 3.5 mm or greater.

Adult↗
PubMed2005

The safety of low molecular weight heparin therapy during labor.

OBJECTIVE: Current recommendations are to discontinue low molecular weight heparin (LMWH) at least 24 hours prior to labor induction or administering epidural anesthesia. We assessed the safety of discontinuing LMWH 12-24 hours before delivery. METHODS: We evaluated the prevalence of hemorrhagic complications during labor, cesarean or epidural catheter placement in 284 women treated with enoxaparin during pregnancy as compared with 16132 untreated women. Treated participants were divided into subgroups by the various intervals between last LMWH dose hemorrhage-prone events (vaginal delivery,epidural, cesarean etc.). The rate of hemorrhagic complications and hemoglobin values were compared between the study and control groups. RESULTS: Postpartum hemorrhage was uncommon and occurred in 2.1% and 1.9% in study and control groups, respectively (p=0.13). Antenatal as well as postnatal hemoglobin values were very similar for treated and untreated women. No differences were noted between women who discontinued enoxaprin 12-24 hours before labor and those who discontinued treatment later with regard to maternal hemorrhagic complications. No spinal hematomas were report among 12792 treated and un-treated women who had epidural or spinal block. No hemorrhagic neonatal complications were encountered. CONCLUSION: Discontinuing LMWH more than 12 hours before delivery is safe in relation to maternal hemorrhagic complications.

Adult↗