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PubMedDate not supplied

What do you do when the baby is winking at you? Case report of a face presentation.

Face presentation is an uncommon presentation at birth. The identification of a fetus with a hyperextended neck on ultrasound antenatally warrants close scrutiny for other anomalies. A fetus who presents as a face presentation in labor that is of average estimated fetal weight and has no anomalies in a woman with an adequate pelvis is likely to deliver vaginally if the mentum rotates to anterior prior to birth. Persistent mentum posteriors are best left alone without manual intervention and delivered by cesarean section. Prolonged labor is common. The clinician must be patient and closely monitor descent and rotation. Infants born as face presentations should be assessed closely after birth for normal respiratory transition and the presence of significant pain warranting analgesics.

Delivery, Obstetric↗
PubMedDate not supplied

Intrapartum screen for diabetes in patients without prenatal care: use of labor admission serum glucose.

OBJECTIVE: For patients presenting in labor with no prenatal care, a rapid screening test for gestational diabetes would potentially aid in decisions for tocolysis (e.g., preterm patients) and mode of delivery (e.g., large for gestational age). We sought to determine whether a labor admission serum glucose is of predictive value in the diagnosis of gestational diabetes. METHODS: We obtained labor admission glucose values for laboring patients and compared these with 1-h (50-g) postglucola (1 degree PG) screens obtained at 24 to 32 weeks' gestation. Diabetics being treated with insulin were excluded from the study. Labor admission serum glucose values were compared to 1 degrees PG values by linear regression. Sensitivity and specificity of admission glucose for identification of a positive 1 degree PG (140 mg/dl) were evaluated by a receiver operator curve (ROC). RESULTS: A total of 98 patients with both 1 degree PG screens and labor admission glucose were identified. Linear regression showed no significant correlation of labor admission glucose and 1 degree PG values (r = 0.13; P = 0.9). The ROC failed to demonstrate an optimal admission random glucose cutoff value for diagnosis of diabetes. CONCLUSIONS: In laboring patients without insulin-requiring diabetes, labor admission glucose does not predict an abnormal 1 degree PG and thus does not aid in labor management of patients with suboptimal prenatal care.

Adult↗
PubMed1992

Trends in preterm labor.

Preterm birth has been identified by the National Commission to Prevent Infant Mortality (1988) as the primary cause of the increased infant mortality rate in the United States. An analysis of what is currently known about four areas of preterm labor including (1) definition and causes, (2) identification of patients at risk, (3) management techniques, and (4) use of patient education in labor is presented in this paper. Preterm labor is defined as uterine contractions that occur between 20 and 37 weeks' gestation with progressive cervical dilatation or effacement or both. Directions for future research are discussed.

Female↗
PubMed1987

Method and route of delivery in the low birth weight vertex presentation correlated with early periventricular/intraventricular hemorrhage.

Two hundred eighty patients with vertex presentation who were in spontaneous labor and delivered neonates weighing 2 kg or less were examined for early ultrasound evidence of periventricular/intraventricular hemorrhage. This was correlated retrospectively with delivery route (cesarean section versus vaginal delivery) and delivery method (low forceps delivery versus normal spontaneous delivery) in the group born vaginally. No correlation was evident between early periventricular/intraventricular hemorrhage and delivery route or method.

Apgar Score↗
PubMed2002

Maternal Arnold-Chiari type I malformation and syringomyelia: a labor management dilemma.

Arnold-Chiari type I malformations consists of elongation of the cerebellar tonsils with their displacement below the foramen magnum. Syringomyelia is an associated cyst that accumulates cerebrospinal fluid in the cord that can impinge on local nerve fibers. Pregnant women with either of these disorders are of special concern due to the potential risk of brain stem herniation and or spinal column compression from physiological changes that occur during labor. We present two cases. The first case is a patient with syringomyelia who was admitted in labor with worsening peripheral neurological symptoms. Epidural anesthesia was placed and she underwent an uncomplicated cesarean delivery with resolution of her symptoms postpartum. The second case is a patient with an Arnold-Chiari type I malformation and syringomyelia who presented in labor. The patient had an epidural placed and was allowed to progress to complete dilation and effacement at +2 station. She underwent a successful operative vaginal delivery without voluntary maternal expulsive efforts. Both patients had uncomplicated postpartum courses. Although these are rare disorders with significant potential morbidity, labor can be managed by either mode of delivery with careful patient selection. We caution that this review has insufficient numbers of patients to address the safety and efficacy of either delivery mode but rather focuses on alternatives for delivery. This report is the first to document a case of a patient with an Arnold-Chiari malformation and syringomyelia successfully managed in labor with a vaginal delivery.

Adult↗