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PubMed1994

[Is moderate labor stress for newborn infants an advantage? Pilot study of postpartum weight gain of 791 newborn infants].

Neonatal weight development in the first 5 postpartal days is favourably affected by intrapartal stress factors. 1. Pathological CTS during delivery were registered for every 8th infant. Slight postpartal weight loss occurred twice as often in this group, compared with the other newborns. The incidence of distinct weight decrease was the same in both groups. On the 5th postpartal day, almost double the number of infants with pathological CTG had either reached or exceeded their birth weight, compared to the normal CTG group. 2. Green amniotic fluid coincided with slight weight loss in double the number of affected children, compared to the rest of the study group. 3. Slight postpartal weight loss was seen more often in neonates with umbilical cord-pH values of up to 7.20 than in infants with pH values exceeding 7.20. Distinct postpartal weight loss was, however, not more frequent in the former group. 4. The birth mode of the 791 newborn was as follows: 16% Caesarean section, 7% vaginal forceps delivery, and 77% spontaneous birth. On the 5th postpartal day 11% of the forceps-delivery infants, 17% of the spontaneous births and 30% of the neonates delivered by Caesarean section had not regained their birth weight. 5. PDA on vaginal delivery was applied to one-third of the women. Slight postpartal weight loss was seen twice as often in these infants, compared to the others. In conclusion, the study reflected, that intrapartal stress aids transition to extrauterine life via "catecholamine peaks". Our current birth monitoring methods may therefore require revalidation with regard to set pathologic limits, using the adaptation parameter of neonatal weight development.

Acid-Base Equilibrium↗
PubMed1994

[Induced labor with prostaglandin E2 gel after previous cesarean section].

With the rising rate of Caesarean sections, the number of pregnant patients with a previous Caesarean is increasing. Taking into consideration certain contraindications, it seems to be justified, to attempt induction of labour for vaginal delivery without major risk. However, the use of prostaglandins for cervical ripening in women with an unfavourable cervical status is particularly controversial. Thus, we analysed data from 385 trials of vaginal labour induction in a total of 522 patients with previous Caesarean section. Single or multiple cervical doses of prostaglandin-E2-gel had to be administered because of an unripe cervix (Bishop-score < 8) in 161 women for induction of labour for medical indications. 84.9% of those patients, in which labour induction was attempted after previous Caesarean section, delivered vaginally; 70% after two Caesareans. The highest success rates were seen after previous Caesarean for breech presentation, while there was still a vaginal delivery rate above 60% even after Caesarean for cephalopelvic disproportion or failure to progress. Maternal and foetal complications were seen with equal incidence in both study groups. Uterine ruptures totalling 0.5% were seen only in patients without cervical priming. Taking into consideration contraindications, intracervical application of PGE2-gel is a safe and effective method, even in patients after previous Caesarean section with clear advantages in case of an unripe cervix.

Administration, Intravaginal↗
PubMed1994

[Umbilical cord entanglement and color-coded Doppler ultrasound].

The incidence of umbilical cord entanglement is about 20-33%. The present study describes the antepartal detection of nuchal cord using Colour Doppler sonography. In 137 cases, the identification of cord entanglement through a high resolution real-time Colour Doppler equipment (Picker 192/Acuson 128 XP) was achieved with sensitivity of 97%, the positive predictive value was 89%, the negative predictive value 96% and the efficiency 93%. In complicated cases, the pulsed Doppler sonography of the cord vessels provided significant differential diagnostic evaluation (Aa. and V. umbilicales vs. uteroplacental vessels). The use of this new method is especially indicated in situations with uncertain variable decelerations and/or other abnormal findings in the antepartal FHR-registration. The early recognition of a nuchal cord could possibly prevent serious peri-/subpartal complications in many cases. The result of our investigations suggest, that once a cord entanglement has been identified sonographically, the antepartal cardiotocography, sonography, Doppler flow examination and intrapartal foetal monitoring should be more frequently and intensively performed.

Apgar Score↗
PubMed1991

[Effect of pregnancy and perinatal parameters--including mode of delivery--on survival rate of "low birth weight premature infants" (less than 1,500 g)].

A retrospective analysis of 225 very low birth weight infants (less than 1500 g) was made, to assess the influence of the mode of delivery on the survival rate. In 186 preterm deliveries which could not be prevented by therapeutic measures, we included additionally certain gestational and perinatological parameters. Generally, an average survival rate of 72% was found in this study. In addition to the well-known negative influence of birth weight less than 1000 g and gestational age of less than 28 weeks, such parameters as antenatal pre-pathological CTG findings, haemorrhages at the time of hospitalisation, and ineffectuousness of tocolytic drugs, were associated with a reduced survival rate. In contrast, the presence of anamnestic risk factors of preterm delivery and prolongation of gestation by one day and more improved the survival rate. Additional consideration of foetal presentation showed, that abdominal delivery was fundamentally safer in cases with breech and transverse presentation. Whether a higher survival rate can be achieved by vaginal delivery in cases of breech presentation with premature rupture of membranes or a gestational age greater or equal to 28 weeks, remains to be proved. A gestational age of less than 28 weeks or antenatal prepathological cardiotocographic findings will facilitate in future the decision to perform Cesarean section in cases of inevitable premature deliveries with cephalic presentation.

Cesarean Section↗
PubMed1990

[Macrosomia of the fetus and clinical relevance].

The clinical relevance of foetal macrosomia (i.e. birth weight greater than or equal to 4000 gms) was investigated retrospectively using the 1987 figures of the "Bayerische Perinatalerhebung". 8591 (total n = 101931; 8.4%) newborns met the criterion for macrosomia and were compared with two groups of normosomic newborns (birth weight 2500-2999 gms and 3000-3999 gms). The problems, which may obscure correct prenatal diagnosis are discussed. The incidence of operative deliveries and birth injuries was increased. The duration of the deliveries was not prolonged in our study in contrast to published reports. The neonatal transfer-rate to a neonatal centre was higher in newborns, delivered by Caesarean section, compared with newborns delivered by the vaginal route. The perinatal and the maternal morbidity was higher, the perinatal mortality lower in the macrosomic newborn. According to our data, macrosomia represents and elevated perinatal risk.

Asphyxia Neonatorum↗
PubMed1994

Fractured clavicle in the neonate: a retrospective three-year review.

A hospital-based case-controlled study was undertaken to determine maternal and neonatal characteristics associated with fractured clavicle. A total of 11,604 consecutive vaginal deliveries of liveborn infants in vertex presentation at the Mount Sinai Hospital from 1988 to 1990 were reviewed. Maternal and neonatal characteristics were compared for the neonates with and without a diagnosis of a fractured clavicle. Compared to controls, mothers of neonates with a fractured clavicle were more likely to be nulliparas or primiparas, to have had an operative vaginal delivery, and to have been delivered by an attending as opposed to a resident physician. The fractured clavicle group also had a longer gestational age, greater birthweight, and higher frequency of macrosomic infants. After controlling for maternal parity, type of delivery and infant birthweight, experience of the delivering physician, and gestational age at delivery were not significantly different. Fracture of the clavicle in the neonate is related to maternal parity, mode of delivery, and infant birthweight but not to the level of experience of the delivering physician.

Adult↗
PubMed1993

The Iowa premature breech trial.

A prospective, randomized clinical trial involving patients in premature labor (28 to 36 weeks' gestation) with breech presentation comparing 18 with immediate cesarean section with 20 with observed labor was undertaken at the University of Iowa from 1978 to 1983. The "observed labor" group had more deaths and lower Apgar scores (not statistically significant). Acidosis at delivery was not more common in the observed labor group, but 25% were delivered by cesarean section for fetal distress. The only neonatal deaths of nonanomalous babies, who were acidotic at delivery, occurred in patients who were managed outside of the trial, because delivery occurred soon after admission to the hospital. Congenital malformations accounted for one-third of the neonatal deaths; birth trauma did not occur in the 38 study patients.

Apgar Score↗
PubMed1993

[Early detection of hearing disorders. 10 years experience with screening more than 8,000 infants].

Prevention and early detection of deficits of the developing human being demand more and more complex solutions. Screening programmes have been developed to detect deficits and diseases before they cause symptoms. A well-organised and accurately performed screening programme can detect preliminary signs of diseases and may prevent irreversible damage. Early detection of deficits only makes sense if it is followed by consequences. Not only early detection of impairment or of children which are threatened by impairment is a very important medical task, but also the interdisciplinary cooperation in therapy. The most serious impact of hearing deficits in newborn is on the lack of speech-acquisition. It is an indisputable fact that the early detection of hearing impairment in newborn markedly improves the prognosis for further language development if early medical and/or rehabilitative therapy takes place. The following description of 10 years of experience with a newborn hearing screening programme that is effected in cooperation with the maternity ward and the ENT-clinic since 1981, can supply further arguments in favour of the need for early detection, the discussion on reflex audiometry, and to emphasise the need for cooperation of all relevant specialists.

Acoustic Stimulation↗
PubMed1985

Preinduction cervical priming with PGE2 intracervical gel.

A prospective, randomized, controlled clinical trial was conducted to evaluate the safety and efficacy of a single, 0.5-mg dose of prostaglandin E2 gel in a shelf-stable triacetin base administered intracervically in patients with an unfavorable cervix (Bishop score less than or equal to 4) 12 hours prior to oxytocin-induction of labor. forty-eight evaluable patients were enrolled, 25 in the PGE2 group and 23 in the control group. PGE2 gel treatment resulted in a significant improvement in the mean Bishop score compared to control (3.14 versus 0.70, P less than .00005). Sixty-four percent of the patients treated with PGE2 had regular uterine contractions during the 12-hour preinduction period beginning 2.18 +/- 2.0 hours after gel insertion, compared to 9% in the control group, P = .0001. Moreover, 12% (3/25) of the patients receiving PGE2 progressed into active labor and delivered during the preinduction period. The duration of oxytocin infusion required for the induction or augmentation of labor was significantly shorter for patients who received intracervical PGE2 gel compared to the control group (13.1 +/- 8.1 versus 19.0 +/- 8.7, P less than .05). However, there was no significant difference in the incidence of cesarean section between the two study groups (40 and 22% in the PGE2 and control groups, respectively). No episodes of uterine hypertonus or hyperstimulation or gastrointestinal side effects occurred as a result of PGE2 gel treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1988

[The older primipara: labor induction and rigidity of the soft tissues].

Textbooks and literature reports frequently view the primipara of advanced age as a group being at increased risk of prolonged labor, dystocia, injuries to the birth canal and fetal distress. Particularly, a rigid cervix and reduced elasticity of the soft tissues of the birth canal are claimed responsible for these risks. Clinically, this view causes a higher frequency of operative deliveries in this group of primipara. The aim of the study was to evaluate the influence of a rigid cervix and/or reduced elasticity of the soft tissues in the birth canal on the course of labor. According to the definition of the FIGO we identified 201 primipara of advanced age as being more than 35 years old in our database. 5966 primipara (age 18-34) served as control. No significant difference was found in regard to Bishop score, progress of labor, vaginal and perineal lacerations, fetal distress and anaesthesia. However, the overall frequency of operative deliveries was increased from 27% to 58% in the primiparas of advanced age. In particular, the incidence of caesarean section increased from 11.5% to 39%. In 66% rigid tissues were called as one of the reasons for operative delivery in this group of aged primipara. However, our analysis of clinical variables does not support the notion that these women in general have an increased frequency of dystocia and/or a more rigid cervix and decreased elasticity of the birth canal. We feel that in a considerable number of patients, the concern of the obstetricians and the women in a safer and less painful delivery by caesarean section are reasons for these increased operative procedures at the end of the reproductive period.

Adult↗
PubMed1988

[Optimal time for labor induction in premature rupture of fetal membranes after the 37th week of pregnancy].

Object of the analysis were 298 births with premature rupture of membranes. Authors examine the complications of birth dependent of time between premature rupture of membranes and beginning of labour; they compare their own results with such of known investigations. In respect to infection morbidity there are stated significantly differences between delivery with and without premature rupture of membranes only when the interval between rupture of membranes and beginning of labour were long; when this interval was less than 6 hours, the infection morbidity even seems to be lower. The same fact authors stated generally for all multiparae. Significantly differences are also stated in respect to frequency of operative deliveries. The fact, that in cases of premature rupture of membranes near term--that's to say: by mature fetus--birth-throes are released, is advantageous; authors conclude, that a time of 5 hours after rupture of membranes is optimal for induction labour.

Cesarean Section↗
PubMed1989

[Data from the Bavarian perinatal survey on the problem of the incidence of cesarean section].

Data are presented on caesarean section rates during the first five-year period of the Bavarian Perinatal Study (BPE 1982-1986), comprising 450,000 births. In order to identify long-term trends, statistical studies from the Munich Perinatal Study (MPS) dating back to 1975 were continued in the same Munich hospitals through to 1982-1984. The results may be broken down as follows: 1. The overall rate of caesarean sections has been increasing, steadily, reaching 15% in the 1986 BPE. No clear levelling-off is evident yet. 2. The highest rates of caesarean sections and vaginal operative deliveries were found in university hospitals. Spontaneous deliveries occurred least often in university hospitals (about 70%), and most frequently in the larger country and private hospitals (77-79%). Smaller externally staffed private hospitals had about the same rate of vaginal-operative deliveries as university hospitals. 3. Following caesarean section, postoperative complications prompted a three- to sixfold higher rate of maternal transfer to other hospitals over that following spontaneous delivery. 4. As maternal age increases, so does the rate of caesarean section for primiparae. Nevertheless, recent years have witnessed a levelling-off for women over 34 years of age. No trend toward further increase is evident for this age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Eye diseases and control of labor. Studies of changes in the eye in labor exemplified by subconjunctival hemorrhage (hyposphagmas)].

The possible significance of subconjunctival bleedings (hyposphagmas) as a symptom for other pathological changes of the eye was studied in a group of 354 postpartum patients. They were found in 10.5% of the cases. A relatively higher frequency occurred in primiparas. No other maternal factors than parity were detected as of statistically significant influence. A slightly higher percentage in mothers with large newborn (above average cranial circumference) indicates a relationship to the necessary bearing-down effort. In a second study, 49 postpartum women with subconjunctival bleeding were examined by an ophthalmologist. Neither any intraocular or retrobulbar bleeding nor any other grievous damage to the eye were found. In accordance with the literature we recommend, that highly myopic pregnant women (even with a previous history of retinal detachment, but ophthalmologically sufficiently treated) should undergo induced delivery. However, the approach to pregnant women with retinal detachment occurring and treated during pregnancy, or to glaucoma-patients with risk to a small remaining visual field, should be more careful. In those cases, a vaginal operative delivery procedure (forceps, vacuum-extraction) is recommended. Nevertheless, one should consider individual wishes of the mother, when striving to diminish the risk to the foetus. The same applies to irrational fears related to previously damaged (and possibly only functional) eye.

Adult↗
PubMed1986

[Sonographic evaluation of the quantity of amniotic fluid. II. Oligohydramnios--significance for the course of pregnancy and labor].

3,274 pregnant women were examined sonographically in this study, with particular emphasis on the quantity of amniotic fluid present. In 8% of the patients a reduced amount of amniotic fluid was seen. If the largest pocket of amniotic fluid was less than 2 cm that particular case was classified as oligohydramnios. If the largest pocket of amniotic fluid was between 2 cm and 3 cm, it was assumed to be in the lower standard range. These cases were compared with a randomly selected control group with normal amounts of amniotic fluid, in respect of the occurrence of complications during gestation and delivery and of the incidence of fetal malformations. Patients with reduced amounts of amniotic fluid showed signs and symptoms of gestosis more often (p less than 0.001) and delivered more often before the 36th week of pregnancy (p less than 0.001) and growth-retarded children (p less than 0.001) than women with standard amounts of amniotic fluid. The incidence rate of Caesarean section was 42%, and hence far above the standard level (p less than 0.001). In oligohydramnios, 13% (p less than 0.001) of the children had severe fetal malformation, whereas, with an amount of amniotic fluid in the lower standard range, only 5.5% (not significant) showed severe foetal malformation. The stated sonographic criteria are suitable as an objective measure for quantifying the amount of amniotic fluid.

Adult↗
PubMed1988

[Changes in breech delivery].

From 1965 to 1981, 1042 singlets born in breech position were recorded out of 25,004 deliveries, at the München-Harlaching City Hospital. The Caesarean section rate was of 48.3%, the perinatal mortality of children weighing more than 1000 g was 3.8%, the perinatal mortality of prematures born in breech position was 19.7%. We subdivided our group of patients in two subgroups: 500 breech deliveries from 1965-1973, and 542 breech deliveries from 1973-1981. In the first subgroup, the Caesarean section rate was 38%, the perinatal mortality 5.6%, and the perinatal mortality of prematures born in breech position 29.6%. In the second subgroup, the Caesarean section rate was of 57.7%, the perinatal mortality was 2.2%, and the perinatal mortality of premature breech deliveries 8.4%. Since the prospective management of delivery, the perioperative conditions, the reanimation possibilities, and the close contact to a newborn intensive care unit, remained unchanged throughout the entire observation period, we tend to correlate the different results obtained in the both subgroups with the different Caesarean section rates recorded. We therefore consider that the consistent prospective delivery management with ample indication to Caesarean section, is also in the Management of a breech delivery even more important than the obliged indication to Caesarean section.

Birth Weight↗
PubMed1986

[Smoking in pregnancy].

The course of pregnancy and delivery and the foetal outcome of women who smoked during pregnancy (n = 1751) were compared with nonsmokers (= 4937). The following variables were studied in retrospect: Duration of pregnancy, maternal weight gain, mode of delivery, foetal birthweight and the maturity of the newborn, Apgar scores, pH of the umbilical artery, perinatal mortality, frequency of foetal malformations, amount of amniotic fluid and the incidence of meconium staining, placental weight and the occurrence of placental infarctions. Birth weight, foetal length and head circumference were significantly smaller in the group of women who smoked. The incidence of babies with low birth weight and clinical signs of prematurity as well as placental infarctions was significantly increased in the same group. Gestational age was not different in smoking and nonsmoking gravidae. No statistical difference was found in the rate of C-sections, in Apgar scores, umbilical arterial pH, the incidence of malformations, perinatal mortality, and placental weight. Social factors were not considered in this study.

Apgar Score↗
PubMed1985

[Significance of pregnancy and labor complications for the genesis of brain function disorders. Results of an epidemiologic study of 8-year-old children].

An epidemiological and a clinical study were conducted to examine the importance of pregnancy and delivery complications in the genesis of cerebral dysfunction, the studies comprising a total of 495 children of 8 years of age. In the case definition of cerebral dysfunction, methodic improvements were used that had been demanded by those who had been critical of the clinical procedure. The results showed that clinical dysfunction is a risk factor for diseases in child psychiatry. There were no signs pointing to uniform psychopathological patterns (on the lines of a hyperkinetic syndrome) in children with cerebral dysfunction. There was no enhanced incidence of other diseases in the anamnesis of children with cerebral dysfunction. On the whole, the concept of cerebral dysfunction cannot be upheld at least to the extent presumed so far. A comparison between field study random samples and clinical study random samples showed that the classical postulates of the concept apply at most to a negligible minority only.

Brain Damage, Chronic↗