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A case of hydrops fetalis due to placental chorioangioma.

A case of an infant born in association with a large chorioangioma of the placenta is reported. The mother was complicated with polyhydramnios and premature labor. The fetal complications were congestive heart failure and hydrops fetalis. This case serves to emphasize that it is necessary to examine the placenta in every perinatal autopsy case.

Female↗

Misoprostol induction of labor among women with a history of cesarean delivery.

OBJECTIVE: Several reports have appeared of uterine rupture among women with a history of cesarean delivery who received misoprostol for induction of labor. A recent review suggested a uterine rupture rate of almost 6%, but the experience at our institution did not seem to reflect this high complication rate. This study was undertaken to compare complications of labor induction with misoprostol between women with a history of cesarean delivery and women without uterine scarring. STUDY DESIGN: A computerized database was used to select women with a viable fetus who underwent induction of labor with misoprostol during the period from January 1996 through December 1998. Patients were given 50 microg misoprostol every 4 hours. Women with a history of cesarean delivery were retrospectively compared with those without uterine scarring. RESULTS: A total of 425 women were given misoprostol for induction of labor: 48 had a history of cesarean delivery and 377 did not. Women with a history of cesarean delivery were more likely to be delivered abdominally (56% vs 28%; P <.04). Among women with a history of cesarean delivery, women who had a history of vaginal birth after cesarean were more likely to be delivered vaginally (92% vs 42%; P =.003). There was no difference in the overall rate of complications (2% with scarring vs 3% without scarring). There were no uterine ruptures. However, the previous cesarean group was more likely than the unscarred group to have blood loss >500 mL (38% vs 22%; P <.03). Although the incidences of fetal distress were similar, neonates born to women in the previous cesarean group were more likely to have an Apgar score <7 at 5 minutes (13% vs 5%; P <.04). CONCLUSION: Misoprostol induction of labor in women with a history of cesarean resulted in a higher rate of cesarean delivery than was seen among women without uterine scarring but was not associated with a higher incidence of complications. There were no uterine ruptures in either group.

Cesarean Section↗

[Programmed labor: methods, results, guidelines (author's transl)].

The programming of labor (setting the best possbile time under optimal conditions) was carried out in the University Women's Hospital, Freiburg i. Br. between 1970 and 1975 in 1121 cases. No perinatal mortality was reported. The secondary frequency of cesarean section for this primarily uncomplicated labor was 3.21% (general hospital statistics for this time period: 6.29%). The most important factors for the strict standardized method of induction is the observation of the pelvic score (desired: greater than 6) and a moderate dose of oxytocin or prostaglandin based on the essential amniotomy. In a statistical comparison of three groups of patients (n = 786): programmed labor (n = 427), induction via the same type of method where transference was suspected (n = 158), and uncomplicated spontaneous labor (n=183), the results with induced labor were better than those with spontaneous labor. In addition for the fact that the course of labor could be preplanned and the period of labor shortened intrauterine and partal complications occurred less frequently with programmed labor than with spontaneous labor. Placental complications and the tendency toward postpartum atony must be discussed. Minor complications decreased as the weight, length and gestation period of the newborn increased. Individual palpation until the physiological maturity for birth is reached would, therefore, seem to be required. Observe the conditions and increase antepartal controls. Only by setting the exact time for labor with modern methods of supervision is it theoretically possible to eliminate the danger of active management. The organizational problem involved with a general programming of labor poses the major problem at present.

Cesarean Section↗

Vaginal delivery in the grand multipara following previous lower segment cesarian section.

OBJECTIVE: To examine the effect of attempting vaginal birth after cesarian section in the grand multipara with one previous cesarian section scar in the uterus. METHOD: Over 5-year period (1990-1994) mothers with 6 or more previous deliveries and with a previous section scar in the uterus were identified. The outcome in these patients who attempted vaginal birth was reviewed. RESULTS: Of the 85 patients with the combination of both grand multiparity and a previous cesarian section scar in the uterus, 45 attempted a trial of labor. Twenty-seven patients (60%) achieved successful uncomplicated vaginal delivery. There was a relatively high incidence of serious complications. CONCLUSION: Vaginal birth after cesarian section can be achieved in some grand multiparas with a previous scar in the uterus. There is an increased risk of serious complications. The labor should be very closely supervised and early intervention arranged if there is not smooth rapid progress.

Cesarean Section↗