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Symptoms and signs with scar rupture--value of uterine activity measurements.

To evaluate the symptoms and signs of scar rupture with special reference to intrauterine pressure measurement a retrospective analysis of labour records of those women who had trial of labour with a previous Caesarean scar in the National University Hospital over a period of 6 years (1985-1990) was carried out. Known symptoms and signs associated with scar rupture, cardiotocographic tracings and fetal and maternal outcome in these patients were studied. Of the 1,018 women with previous Caesarean scar (4.2% of our pregnant population at term) 722 (70.9%) had trial of labour; 70% delivered vaginally. There were 4 (0.55%) incomplete and 5 (0.69%) complete scar ruptures. All 9 women had an oxytocin infusion; 3 were diagnosed postdelivery (all 3 had complete ruptures); 3 of the 6 who had rupture prior to delivery had sudden reduction in uterine activity, 1 had scar pain and prolonged bradycardia and 2 had no symptoms or signs. Continuous cardiotocography with intrauterine pressure measurements may help to identify scar rupture early and may be of value especially in those who have an oxytocin infusion.

Apgar Score↗

[Sexual behavior during pregnancy (author's transl)].

In a sample of 239 women in the immediate post-partum period a detailed interview concerning their sexual behavior during pregnancy was conducted. It was found, that the sexual activity declines constantly during the pregnancy-period. Women, who reported a high sexual activity before pregnancy tended to be more active throughout pregnancy. Rate of sexual activity was negatively influenced by a poor relationship to the male partner. This impairment seems to be more essential than the influence of physical symptoms. Women with a positive attitude towards pregnancy also showed a higher rate of sexual activities. It was shown, that relaxed behavior during birth is positive correlated with a high coital frequency before and during pregnancy. There was no relationship between coitus in late pregnancy and complications during birth.

Adult↗

A five year review of scar dehiscence in the Rotunda Hospital, Dublin.

The aims of this study were to identify risk factors for scar dehiscence in labour, to illustrate the clinical presentations of patients with scar dehiscence and to quantify the risk posed by the use of oxytocin in labour. This was a case controlled, 5 year retrospective study. Patients with scar dehiscence were identified from labour ward records with matched controls and chart review of case and control patients were performed. Our results showed that the vaginal delivery rate for trial of scar was 76.9%. The incidence of scar dehiscence was 0.043%. Oxytocic labour augmentation was a risk factor (OR 4.5, 95% CI 0.9313-42.8, p=0.065) but induction of labour using oxytocin was not (p=0.222). The commonest symptom of scar dehiscence was fetal distress (OR 12.3, 95% CI 1.9-81). There was no maternal or fetal mortality. We concluded that trial of labour after one caesarean section is acceptable practice with a good success rate and a low incidence of serious morbidity. The use of oxytocin to augment labour is associated with scar dehiscence.

Adult↗

Prolonged labour.

Although prolonged labour may be a decreasing obstetrical problem, the importance of its implications should not be overlooked. This article discusses the causes of arrested labour, its complications and their management.

Female↗

[Care of the delivery following a cesarean section].

A retrospective study to determine the risks of normal delivery after cesarean section, was done. The inclusion criteria were found in 116 patients in six years covering the study. All the patients were permitted normal delivery and none received ocitocin. Sixty six patients accomplished delivery, which corresponds to 57%. In the rest of patients cesarean section was performed. The probability of ending in delivery was associated to women with three or more gestas. But cephalo-pelvic disproportion and fetal suffering, were associated to greater probability of ending in cesarean section. There was no dehiscence of uterine scar. It is concluded that with well established requisites it is possible to resolve by delivery with a great degree of confidence, at least 50% of cases with previous section.

Adult↗

Promoting vaginal birth after cesarean section.

New data support the safety of vaginal birth after cesarean section (VBAC). Physicians and hospitals that provide standard obstetric care can also provide care for women attempting VBAC. The management of labor in such patients differs little from that in other patients, and an understanding of the normal course of labor in these patients should help eliminate inappropriate interventions. Family physicians can play a major role in promoting VBAC in appropriately selected patients.

Cesarean Section↗

A comparison of spontaneous labor with induced vaginal tablets prostaglandin E2 in grand multiparae.

OBJECTIVE: To compare the outcome of labor in grandmultiparous patients (para >5) who had induction of labor with prostaglandin E2 vaginal tablets with grandmultiparous patients in spontaneous labor, and to observe the complications during induction of labor. METHODS: A retrospective case control study was carried out at King Faisal Military Hospital, Khamis Mushayt between January 1993 through until December 1994. This included 64 grandmultiparous patients that were induced with prostaglandin E2 vaginal tablets. Ninety grandmultiparous patients who went into labor spontaneously served as controls. Maternal and fetal data extracted from their hospital record files included age, parity, indication for induction, Bishop score at induction, total dose of prostaglandin used and complications of induction of labor. Other information were length of labor, need for syntocinon augmentation, blood loss during the 3rd stage of labor, mode of delivery, birth weight, sex and Apgar score at 10 minutes. RESULTS: No serious complication of induction of labor such as rupture of the uterus was noted in the subjects studied. There were no significant differences when the mean age and parity of patients in the 2 groups were compared (P>0.05) but there was difference in the gestational age at delivery (p=0.00). There was no significant difference in the mean length of first and 2nd stages of labor. The cesarean section rate was 11% and 8% in the cases and controls, while the need for syntocinon augmentation was twice in the cases than controls, 27% vs 14%. These were not statistically significant. CONCLUSION: We conclude that induction of labor with prostaglandin E2 vaginal tablets may not have adverse effect on the outcome of labor compared with patients in spontaneous labor. It may be safe to use prostaglandin E2 vaginal tablets for induction of labor in the grand- multiparae. We recommend a randomized prospective trial to validate these observations.

Administration, Intravaginal↗