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At least 1,531 records · Page 85Linked to original sources
PubMed1992

Cigarettes, coffee, and preterm premature rupture of the membranes.

Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).

Adolescent↗
PubMed2004

Mode of delivery after one cesarean section.

OBJECTIVES: To investigate labor patterns and mode of delivery of aginal births after cesarean (VBAC) versus unsuccessful trial of labor after cesarean (TOLAC) in a South African district hospital, and the influence of the indication for the primary cesarean section (C-section) on the subsequent mode of delivery. METHODS: Retrospective audit of the partogram of 202 VBAC and 382 repeat C-section. There were 108 elective repeat cesarean deliveries (ERCD) and 274 emergency repeat C-sections after unsuccessful TOLAC. The indication of the primary C-section was known in 127: 43 (33.9%) VBAC and 84 (66.1%) repeat C-sections. RESULTS: The indication for the primary C-section in terms of recurrent/non-recurrent did not affect the subsequent mode of delivery (chi(2)=3.5; P=0.06; OR 0.49, 95% CI 0.23-1.04). The indication of the primary C-section in terms of dysfunctional/non-dysfunctional labor did not reoccur in the same parturients (chi(2)=0.01; P=0.91; OR 0.94, 95% CI 0.35-2.55). CONCLUSION: Dysfunctional labor accounted for most primary and repeat emergency C-sections, but not as a recurrent condition in the same parturients.

Adult↗
PubMed2003

A randomised controlled trial of admission electronic fetal monitoring in normal labour.

AIM: To test the hypothesis that the use of admission Electronic Fetal Monitoring (EFM) for healthy pregnant women in spontaneous labour would result in an increase in continuous EFM when compared to women who have had no admission EFM. DESIGN: A randomised controlled trial. SETTING: The Midwives Birth Unit in Glasgow Royal Maternity Hospital, a major urban teaching hospital with approximately 5000 births per year. PARTICIPANTS: Healthy pregnant women admitted in normal labour, deemed low risk based on the midwives' birth unit admission criteria. INTERVENTION: Women were randomly allocated either to receive a routine 20-minute period of EFM at the time of admission (control group), or to receive no routine admission EFM (study group). OUTCOME MEASURES: Primary study outcomes, use of continuous EFM; and use of EFM additional to the admission test. SECONDARY OUTCOMES: artificial rupture of membranes, use of fetal scalp electrode, fetal blood sample, syntocinon, epidural analgesia, number of vaginal examinations, rate of transfer to labour ward, and reason for transfer. KEY FINDINGS: There was no statistically significant difference between the groups for use of continuous monitoring, but significantly more women in the control group did receive additional EFM. There was no statistically significant difference between groups for any of the interventions studied. CONCLUSION: The use of admission EFM did not in itself lead to a cascade of intervention. Other factors including setting of care and philosophy of caregivers may have an effect on the rate of intervention in labour.

Adolescent↗
PubMed1997

Predictors of childbirth pain and maternal satisfaction.

There is little multivariate, multiphasic research on childbirth pain and satisfaction. We explored the relationship of demographic, medical, psychological, and environmental variables at different times to multiple indices of pain and satisfaction in 70 primiparae and multiparae. Induced labor, desirability of pregnancy, and coach's helpfulness predicted sensory pain. Duration of labor, depression, and outcome expectancy that childbirth education would facilitate medication-free childbirth predicted affective pain. Physician-anticipated complications, induced labor, and motivation to be medication-free predicted pain intensity. Grade level predicted-satisfaction. The results also demonstrated differences between primiparae and multiparae in the pattern of variables that explained pain and satisfaction as well as the temporal sensitivity of pain predictors. We discuss the implications of our findings for research and practice.

Depression, Postpartum↗
PubMed1994

Use of cervical prostaglandin E2 gel in patients with previous cesarean section.

The aim of this study was to determine whether preinduction cervical ripening with prostaglandin E2 (PgE2) gel in patients with one previous cesarean section may be used with the same safety and efficacy as in patients without a uterine scar. Primiparous patients (n = 94) with one previous cesarean section were retrospectively compared to nulliparous patients (n = 866). Both groups underwent preinduction cervical ripening with 2 mg intracervical PgE2 gel. Logistic regression was performed to control for confounding factors. Our statistical power was 90% for detecting a doubling of the complication rate, from 10 to 20%. There were no significant differences in the duration of ruptured membranes or length of labor between the two groups. No significant differences were detected in the rate or indications for cesarean section, presence of thick meconium, epidural anesthesia use, amnionitis, or maternal and neonatal morbidity. There were no cases of uterine rupture in either group. PgE2 gel may be used with the same safety and efficacy in patients with previous cesarean section as in nulliparas.

Administration, Intravaginal↗
PubMed1989

Trial of labour after previous caesarean section: obstetric outcome.

Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28-month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth-weights revealed a trend towards more repeat Caesareans with increasing birth-weight beyond 2,500 g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour. A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.

Birth Weight↗
PubMed2000

Predicting the success of a trial of labor with a simple scoring system.

OBJECTIVE: To determine the applicability of a simple scoring system, by Troyer and Parisi, in predicting the success of a trial of labor among parturients with prior cesarean delivery. STUDY DESIGN: Retrospectively, all patients who underwent a trial of labor over six consecutive years were reviewed. chi 2, Fisher's exact test and analysis of variance followed by the Turkey or Dunn test were used when appropriate. P < .05 was considered significant. RESULTS: There were 263 trials of labor, of which 63% (167) ended in vaginal delivery. While 21% had a score of 0, 40%, 28% and 11% had a score of 1, 2 and at least 3, respectively. The frequency of vaginal birth was significantly different between the four groups (P < .001): 98% for a score of 0, 69% for 1, 40% for 2 and 33% for 3-4. Occurrence of cesarean delivery for cephalopelvic disproportion (2%, 24%, 39%, 56%; P < .001) or for a nonreassuring fetal heart rate tracing (0%, 7%, 21%, 11%; P < .001) was significantly different between the four groups. CONCLUSION: In our population, we confirmed the inverse relationship between the Troyer-Parisi scoring system and a successful trial of labor.

Adult↗
PubMedDate not supplied

Outcome of term breech by intended mode of delivery.

BACKGROUND: The optimal mode of delivery for the term breech fetus is undetermined. METHODS: Over a 10-year period, the outcome of 157 planned caesarean sections and 265 trials of vaginal delivery for the matured, selected, singleton breech presentation were compared. RESULTS: The perinatal mortality among the planned vaginal group was not statistically different from the planned caesarean group (3.0% vs 0.6%, p = 0.102), so was the incidence of birth asphyxia (9.4% vs 4.5%, p = 0.06), admission into neonatal intensive care unit (13.6 vs 7.6%, p = 0.063) and neonatal birth injury (3.4% vs 0.6%, p = 0.072). The overall maternal morbidity was 28% in the planned caesarean group, and 9% in the planned vaginal group, p = 0.025. CONCLUSION: Given appropriate selection criteria and management protocol, the outcome from elective caesarean section might not be better than that from planned vaginal delivery.

Birth Injuries↗
PubMed1990

International differences in the use of obstetric interventions.

This study investigated current levels and trends between 1975 and 1986 in the rates of cesarean section in 21 countries and of operative vaginal delivery in 14 countries. Sharp differences in national obstetric practice were found, with cesarean rates ranging from a high of 32 (Brazil) to 7 (Czechoslovakia) per 100 hospital deliveries, and operative vaginal rates from 16 (Canada) to 2 (Czechoslovakia) per 100 hospital deliveries. For most countries, rates of cesarean section have risen as operative vaginal rates have fallen, but some important exceptions exist. A comparison of cesarean section rates for two complications of labor and delivery that can be objectively diagnosed, multiple births and breech delivery, demonstrates that cesarean section rates for these complications rose sharply in almost every country from 1980 to 1985. A comparison of 1985 national rates of intervention and measures of birth outcome found no significant relationship between the two. While such ecological comparisons are imperfect at best, this does indicate that low levels of early infant mortality can be achieved in some populations despite a low rate of cesarean deliveries.

Australia↗
PubMed1993

Management of breech presentation at term.

The management of 159 consecutive women with singleton breech presentation occurring at 37 or more weeks of gestational age was reviewed. They were stratified into three groups: (a) caesarean section without trial of labour (87), (b) trial of labour resulting in caesarean section (21), and (c) trial of labour culminating in successful vaginal delivery (51). The criteria for allowing a trial of labour were described. Careful review of material and foetal variables indicated that a trial of labour in carefully selected patients resulted in vaginal delivery in 70.8% and that this was achieved without an increase in foetal or maternal mortality or morbidity.

Adult↗
PubMed2005

Maternal anterior sacral meningocele in pregnancy.

Anterior sacral meningocele is a rare condition resulting from herniation of the meninges through a sacral defect. Women with this condition may undergo inappropriate surgery because the correct diagnosis is missed, resulting in serious complications. In labor, the cyst may rupture, with consequent meningitis and high maternal mortality. We report the case of a 31 year-old pregnant woman with an anterior sacral meningocele. We describe the role of magnetic resonance imaging in the evaluation and management planning in this condition. She was delivered by cesarean section at 34 weeks without complications. Accurate diagnosis and delivery by cesarean prior to labor are important in assuring good outcomes in women with anterior sacral meningoceles.

Adult↗