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PubMed1985

[The position of the human fetus during pregnancy and the probability of spontaneous rotation to the vertex position in primi and multiparae].

Now that ultrasonography is a routine examination in pregnancy, breech presentations are frequently diagnosed. On the basis of 4066 individual examinations a graph was drawn indicating the relative frequency of breech, vertex and transverse presentations in the course of pregnancy. There are clear, and in some cases statistically significant differences between primiparae and multiparae with regard to the individual presentations. The analysis of several ultrasonographic examinations of one and the same patient makes a prediction possible of the likelihood of the foetus moving from breech to vertex presentation in a particular week of the pregnancy. Here there are clear differences between primiparae and multiparae: thus, the chance that a foetus in breech presentation in the 29th week will move spontaneously into vertex presentation in a primipara is 31.1%, while the degree of probability in multipara is 70.2%. In the 33rd week the probability is 15.5% in primiparae, as opposed to 57.5% in multiparae. From the 37th week on, spontaneous movement into vertex presentation is no longer likely to occur, in either primiparae or multiparae. In the 29th week, on the other hand, the likelihood of a foetus in vertex presentation moving into breech presentation in a primiparae is 0.6%, while in a multiparae it is considerably higher, at 2.3%. From the 33rd week on there is no likelihood of spontaneous movement into breech presentation in either group. Two tables, for primiparae and multiparae, respectively, show the likelihood of movement from one presentation to the other between the 13th and 41st weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Breech Presentation↗
PubMed1998

A prospective study of anal sphincter injury due to childbirth.

BACKGROUND: Faecal incontinence commonly affects women, principally because of childbirth. Our aims were to determine the functional effect of childbirth on the pressures generated by the anal sphincter and to determine the patterns of injury to the sphincter. METHODS: Anal manometry was performed in 53 primiparous women prenatally, in 50 women at a median of 5 weeks postnatally, and repeated in 26 women at a median of 6 months postnatally. In addition, anal ultrasound was performed postnatally. Pelvic floor symptoms were assessed. The mode of delivery was examined to determine what variables affected anal function. RESULTS: Squeeze pressure was significantly reduced (P < 0.001) 6 weeks postnatally (mean, 170.4 cm H2O; standard deviation (s), 56) compared with the prenatal value (mean, 225.6 cm H2O; s, 58). This occurred in symptomatic and asymptomatic women and in women with a normal anal ultrasound. Resting pressure was significantly reduced at 6 weeks (P < 0.001; prenatal mean, 91.6 cm H2O; s, 25; postnatal mean, 80.Ocm H2O; s, 21). Delivery method (vaginal or caesarean) was the only factor significant for the reduced squeeze pressure (r=53.377; standard error, 13.973; P < 0.001). Sphincter defects (41%) were common but did not influence anal sphincter function. CONCLUSION: Anal function was significantly affected by vaginal delivery with short-duration follow-up. This occurred with and without evidence of an anal sphincter injury. The importance of a sphincter injury is questioned.

Adult↗
PubMed1997

Determination of the dose-response relationship for intrathecal sufentanil in laboring patients.

Multiple studies have investigated the efficacy of intrathecal opioids, particularly sufentanil, in laboring parturients. However, until the important pharmacological indices of the 50% and 95% effective doses (ED50 and ED95, respectively) are defined, reliable comparative studies among drugs at equipotent doses cannot be performed. This study was performed to establish the dose-response relationship of intrathecal sufentanil analgesia in labor. Sixty parturients presenting in active labor received intrathecal sufentanil 2.5 (n = 10), 5.0 (n = 10), 7.5 (n = 10), 10.0 (n = 10), 12.5 (n = 10), or 15.0 (n = 10) microg in a blind, randomized fashion. Patient 100-mm visual analog pain scale (VAS) scores, fetal heart rate (FHR), blood pressure, and heart rate were recorded at 0, 1, 5, 10, 15, 20, 25, and 30 min after administration of sufentanil and then again when the patient requested additional analgesia. Absolute VAS < or =25 mm was considered an analgesic success. Percent responders was used to construct a dose-response curve and calculate ED50 and ED95. The ED50 and ED95 for intrathecal sufentanil in laboring parturients were 2.6 (1.8-3.2, 95% confidence interval) and 8.9 (7.5-11.5) microg, respectively. There was a trend toward increasing analgesic duration with increasing sufentanil dose. The maternal side effect profile was not different among groups. FHR did not appreciably change for any group or individual studied. Assisted delivery and cesarean section rates were similar for all groups. Intrathecal sufentanil provides rapid onset of analgesia for labor. The ED50 and ED95 values established in this study should help to provide benchmarks both for the safe clinical use of intrathecal sufentanil for labor and for future comparison studies with other intrathecal analgesic techniques.

Adult↗
PubMed1981

Engagement of the fetal head in the negro primigravida.

A prospective study into causes of non-engagement of the fetal head at term in the negroid primigravida showed no correlation with fetal birth weight nor with the pelvic brim inclination. However, there was a significant difference (p less than 0.05) between the mean head circumference of babies with heads which had not engaged (34.1 cm) and with those which had (33.1 cm). Labour was generally prolonged with a high head at term, but there was no increase in the incidence of fetal or maternal mortality and morbidity nor was it associated with an increase in the rate of operative interference. In addition, retrospective studies on pelvic brim inclination between 31 Nigerian primiparae and matched Caucasians at the Queen Charlotte's Maternity Hospital showed no statistically significant differences. It is suggested that an unengaged fetal head in early labour should not by itself be an indication for early delivery by caesarean section.

Adolescent↗
PubMed1975

Use by general practitioners of obstetric beds in a consultant unit: a further report.

Of 1,700 women booked for delivery by general practitioner obstetricians in a consultant unit, 1,399 had uncomplicated deliveries and the co-operation between practitioner and consultant was an obvious advantage for the 257 who were transferred completely to consultant care during pregnancy, labour, or puerperium. The scheme, which started in 1964, has enabled general practitioners to continue to give complete obstetric care to their patients. The number of participating practitioners has, however, declined from 80 to 16 indicating that many preferred to concentrate on antenatal work.

Adult↗
PubMed1974

Symphysiotomy.

Explore the source record for details and available documents.

Anesthesia, Local↗
PubMed1976

Pelvimetry in breech and cephalic presentation.

Pelvic measurements in a group of 115 women delivering in breech presentation were compared with those in a group of 100 delivering in cephalic presentation. The average pelvic measurements were all a few mm larger in the breech cases and the average sum of the outlet diameters was significantly larger. Pelvic disproportion was not more common in breech presentation and no support was found for the theory that large pelvic measurements predispose to breech presentation. The small differences found are attributed to the moulding of the pelvis occurring during parturition.

Breech Presentation↗
PubMed1994

Partogram of a grand multipara: different descent slope compared with an ordinary parturient.

Partograms of 42 grand multipara women (mean 10 previous deliveries) were analyzed and compared with the partograms of nulli- or second-/thirdpara women. All these full-term pregnancies were normal and the vaginal deliveries were spontaneous and non-instrumental. The grand multiparas had the shortest duration of the latent phase and the second stage of the delivery, but the active slope of the cervical dilation was in all groups same, on the average 2.8 cm/hour. The station of the presenting part of the fetus remained in the grand multipara group significantly higher than in the other parturients for the whole first stage of labor. During this delayed descent the normal rotation of the fetal head from occiput transverse to occiput anterior position was delayed and fetuses were often delivered in a low transverse head position. The cephalopelvic disproportion need not be the most obvious reason for a slow descent in a grand multipara delivery, but slow descent can be caused by the physiological changes due to the great number of previous pregnancies.

Adult↗