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PubMed1982

[Experience obtained from segmental epidural analgesia in obstetrics (author's transl)].

Lumbar epidural anaesthesia was applied for obstetric analgesia to 103 women, most of them primiparae. Three different concentrations of Bupivacain (Markaine) were used for local anaesthesia, percentages being 0.5, 0.375, and 0.25. Effects and side-effects were evaluated. -- The rate of vacuum extraction was slightly increased under epidural analgesia (24.3 per cent), with ejection periods being enlarged to average values between 82 and 63 minutes. Frequency of caesarean sections as well as both the acid-base status and Apgar scores of the newborns were similar to those recordable from comparison groups. -- Advantages were clearly visible and side-effects of minor importance. Catheterisation for lumbar epidural anaesthesia, consequently, is recommended as an optional approach to obstetric analgesia.

Acid-Base Equilibrium↗
PubMed1982

[A review of six years use of a computerised case history in obstetrics (author's transl)].

The University Centre for Gynaecology and Obstetrics in Toulouse have been using a computerised record system for obstetrics since 1974. This makes it possible for a review for a review to be undertaken each year of the work carried out in the Service and has made it possible to study over six years the evolution of the characteristics of the population who have been followed, as well as the changes in attitudes and techniques adopted during pregnancy and labour. A study has been carried out on the factors associated with perinatal mortality and prematurity. Computerisation of 13,500 records has made it possible to draw curves of birth weights, according to the duration of the pregnancy, and characterising the service given. Finally the adoption of a prospective record system used in common by several teams and checked by people specialised in this work has improved the quality and quantity of retrieval and has made it possible to foresee cooperative studies between different departments.

Birth Weight↗
PubMed1980

[Basic statements to standardize electrodiagnostical investigations in obstetrics (author's transl)].

The use of electrodiagnostical investigations became more and more accepted in obstetrics within the last decade; namely rheobase measurements as a means of recognising a threatening premature labour and of checking the effectiveness of tocolytic treatment, and further as an indication of a change in the neurovegetative excitability immediately before delivery. Not only the excitability of the uterine musculature increases before onset of labour but also at the same time, the excitability of the striated skeletal musculature is raised. In obstetrics the electrical excitability usually is tested on the left musculus tibialis anterior but there is a difference in applying the electrodes (unipolar and bipolar technique). Both techniques and the basis of Electrodiagnosis are reviewed in this paper. The advantages and standardisation of the bipolar technique shall be shown.

Electric Conductivity↗
PubMed1980

Ten years' experience in a general practice obstetric unit.

The outcomes of over 8,000 bookings in a general practice obstetric unit closely associated with a consultant unit were surveyed prospectively over a 10-year period. There was a progressive (though erratic) reduction in perinatal mortality rates for all original bookings and for final admissions in general practice care though these appeared to be at the expense of an increasing transfer rate for primiparae both during pregnancy and in labour. The performance of general practice obstetricians was also examined and the implications for the future of general practice obstetrics are discussed.

Adult↗
PubMed1980

X-ray pelvimetry in clinical obstetrics.

X-ray pelvimetry has been used in obstetrics for over 80 years, but its clinical usefulness remains uncertain. Review of 101 consecutive x-ray pelvimetries obtained by Brown's modification of the Colcher-Sussman technique demonstrated the anteroposterior measurements to be of no value in predicting the eventual method of delivery. However, a transverse of the inlet of less than 13.0 cm and a transverse of the midpelvis of less than 10.0 cm were each associated with an increased frequency of operative delivery. In 94 cases no new information was obtained by x-ray pelvimetry; in the other 7 patients the information obtained was equally accessible by either ultrasonography or abdominal scout film. The authors conclude that x-ray pelvimetry by the technique used in their institution has very limited usefulness in clinical obstetrics.

Delivery, Obstetric↗
PubMed1980

Nosocomial infections in an obstetric and gynecologic hospital.

A prospective study was undertaken at Wesson Women's Unit of Baystate Medical Center to characterize and evaluate nosocomial infections. Using Center for Disease Control criteria, 59 of 1,297 patients undergoing obstetric or gynecologic procedures over a two-month period manifested nosocomial infections. The infected patients were proportionately divided between the obstetric and gynecologic services. However, within each group, certain procedures were associated with a greater incidence of postoperative hospital-acquired infection. Patients who underwent primary cesarean sections and vaginal hysterectomies were most at risk of developing nosocomial infections (22% and 19%, respectively). Nosocomial infection is still a major problem to the obstetrician-gynecologist. However, careful study can delineate patients at high risk, allowing appropriate intervention, including the use of prophylactic antibiotics. This may lead to a significant reduction in the incidence of nosocomial infections.

Anti-Bacterial Agents↗
PubMed1994

Combined spinal-epidural block in obstetrics.

Although epidural and spinal blocks are well-accepted regional techniques in obstetrics, they have several disadvantages. Combined spinal-epidural (CSE) technique reduces or eliminates the risks of these disadvantages. The sequential CSE technique can reduce the incidence and severity of maternal hypotension. CSE block combines the rapidity, density and reliability of spinal block with the flexibility of continuous epidural to extend the duration of analgesia. It has been used in thousands of patients without any reports of major problems. Catheter penetration through the dural hole though unlikely is not impossible. Before any injection in the epidural catheter, its position should always be confirmed by aspiration test. The technique should be used only by those who are experienced in spinal and epidural blocks. CSE is an important addition to the armamentarium of the obstetric anaesthesiologist.

Analgesia, Epidural↗
PubMed1994

[Non-recognition of a second fetus in a recumbent cow during veterinary obstetrical assistance (expert opinion)].

The objective of the expert opinion presented in this paper is the missing of a second fetus after veterinary obstetrical assistance in a downer cow. The necessity of a thorough examination after obstetrical manipulation is stressed with special reference to problems occurring in recumbent cows. In addition, possible complications after inappropriate removal of retained placental fetal membranes are discussed.

Animals↗
PubMed1994

Obstetric referral in family practice. Factors Affecting Cesarean Section (FACS) Study Group.

BACKGROUND: This study examines referral patterns of family physicians who perform obstetrics to determine the effects of referral bias on family physician and obstetrician patient populations. METHODS: A retrospective review of deliveries from five medical centers over a 2-year period produced a sample of 2568 women who began their obstetric care with family physicians and 2648 whose labor was initially managed by family physicians. To determine which demographic and risk factors are associated with an increased likelihood of referral, those who were referred to obstetricians before the onset of labor (early referrals) and those who were referred during labor (late referrals) were identified and compared with patients who were not referred. RESULTS: Of the initial 2701 patients who entered care with family physicians, 167 were early referrals and 249 were late referrals. Early referrals were more likely to have had a prior cesarean section (32% vs 3% of those not referred, P < .001) or malpresentation (10% vs 4%, P < .001) than those who were not referred. Among patients referred during labor, previous cesarean section (10% vs 2%, P < .001) and preeclampsia (12% vs 6%, P < .001) were more common. CONCLUSIONS: These data suggest that referral bias is not a major source of differences in patient populations cared for by family physicians and obstetricians.

Adult↗
PubMed1993

[Reserves in decreasing maternal mortality due to obstetrical hemorrhages].

Analysis of 542 lethal cases at pregnancy terms 28 weeks and more, of parturients and puerperae in Russia over 1987-1991 has shown that obstetrical bleedings were responsible for 42.2% of deaths, being the most frequent causes of lethal outcomes. Analysis of records documenting 283 lethal cases has shown a high incidence of somatic (90.9%) and obstetrical diseases (95.5%). Assessment of medica care quality has shown inadequate care of pregnant women and parturients and inadequate emergency care. Prevention of massive blood loss should involve hemostasis studies in pregnant women and parturients and its correction; if a bleeding occurs, comprehensive intensive care and surgical interventions are indicated.

Adolescent↗
PubMed1993

[Obstetric health care offered to Turkish immigrant women--a quality assessment].

The object of this investigation was to make a quality-assessment of the care offered to pregnant and delivering Turkish immigrant women by the Danish health care system. The quality-assessment was made as a Medical Audit using data obtained from relevant medical records as well as from semi-structured interviews with the women. Thirteen cases were evaluated among the 65 Turkish women included in the project by having delivered at Aarhus Kommunehospital in the period between April 1 and December 15 1989. In this material no severe obstetrical deficiencies were found, but other types of deficiencies were observed. Bad communication due to insufficient use of trained interpreters and to the health personnel's lack of knowledge about cultural background often resulted in mutual misunderstandings. Most of the women were examined by many different doctors and midwives during pregnancy and delivery. It is demonstrated, that the lack of continuity was an additional strain of these women. It is concluded that the difficulties in communication are potentially dangerous, increasing the risk of delayed or missing obstetrical intervention. The insufficient communication demonstrated causes insecurity and inappropriate care.

Adolescent↗
PubMed1993

Study on the usefulness of povidone-iodine obstetric cream with special reference to the effect on the thyroid functions of mothers and the newborn.

The effect of povidone-iodine obstetric cream (OAD cream) on the thyroid functions of mothers and the newborn was investigated in 56 patients. Effects on labour and on the neonatal course of the newborn were also studied. OAD cream was used for disinfection of the vulva and vagina during prenatal obstetric examinations (1-10 times) and at parturition. Bacteriological specimens were obtained before and after use of the OAD cream, and the total iodine, thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) levels were measured in the maternal blood and umbilical cord blood. The overall bacterial eradication rate for the vulva was 74.7% although the eradication rate for coagulase negative staphylococci was low (23.1%). The overall bacterial eradication rate for the vagina was 56.1% although the eradication rates for Candida albicans and Lactobacillus spp. were low (9.1% and 29.4% respectively). There was no significant difference in the types of delivery or complications of labour and delivery between the group treated with OAD cream and the control group, but the duration of labour was prolonged in the former group. There were no malformations among the newborn, and no difference between the group treated with OAD cream and the control group in regard to body weight and length of the newborn at birth, Apgar score, postnatal gain in body weight, or bilirubin level. The maternal blood levels of total iodine, TSH, and T4 were within the normal ranges both during pregnancy and at delivery, but the level of T3 was slightly elevated at delivery. The umbilical cord blood levels of the total iodine, TSH, and T4 were within normal ranges both during pregnancy and at delivery, but the level of T3 was somewhat elevated. At age six days, the T4 level was normal in all the newborn. TSH was higher than 15 microU/ml in two newborns, but returned to normal levels three week later.

Antisepsis↗
PubMed1977

The challenge of obstetrics in a developing country.

For the 13 months between 1 May 1975 and 31 May 1976 a prospective study was made in a maternity wing of a hospital in a developing country. Out of 2196 mothers who gave birth, 278 were classified as requiring special care. The rate of caesarean section showed a steep fall, from 30,76% in 1967 to 2,98% in 1976. The rate for the present series was just over 3%. The series has highlighted the challenges the obstetrician has to meet in a developing country. Patients with pre-eclampsia rank high in the admissions, as do patients with a bad obstetric history, Venereal disease is commonly encountered and requires adequate treatment. Lack of adequate medical services is among the important factors responsible for the obstetric difficulties encountered. Lack of communication and transport facilities aggravates the problems of midwives and obstetricians in developing countries. This study shows how a simple plan and hard work by all concerned can achieve commendable results in spite of the overwhelming inadequacies.

Adolescent↗
PubMed1998

Obstetric performance, perinatal outcome and risk of infection to the newborn in spontaneous and artificial rupture of membranes during labour.

OBJECTIVE: To compare the obstetric performance, perinatal outcome and risk of neonatal infection in labour following spontaneous (SROM) and artificial (AROM) rupture of membranes. DESIGN: Prospective, non-randomised, comparative study during a one-month period in 1995. The study was approved by the ethics committee of the Faculty of Medicine, University of Colombo. SETTING: University Obstetrics Unit at De Soysa Hospital for Women, Colombo. PATIENTS: 324 women who were in early established labour after 37 weeks of gestation. 151 of these had SROM and 173 AROM. The AROM and SROM groups among primigravidae and multigravidae were considered separately. RESULTS: Oxytocin use in multigravidae was significantly higher in the AROM group than in the SROM group (p < 0.001). The emergency caesarean section (LSCS) rate in primigravidae was significantly higher in the AROM group than the SROM group (p < 0.001). A significantly larger number of primigravid AROM women had abnormal fetal heart rate changes on auscultation (p < 0.05) and cardiotopographic (CTG) patterns (p < 0.001) when compared with primigravid SROM women. Choreoamnionitis and funisitis were commoner in the AROM group although the difference was not statistically significant. CONCLUSIONS: AROM appears to be associated with a higher chance of fetal distress particularly in primigravidae. Both AROM and SROM are associated with a potential risk of infection at intrauterine sites.

Adult↗
PubMed2004

Obstetrical risks in the older primigravida.

OBJECTIVE: To compare the complications, delivery mode and fetal outcome between elderly primigravidae and young primigravidae. DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, POFs Hospital, Wah Cantt, from January 2001 to December 2002. SUBJECTS AND METHODS: One hundred and fifty six elderly primigravidae were compared with a matched pair group of younger primigravidae regarding antenatal, intrapartum and postpartum complications. Perinatal mortality was also compared. Specially designed proforma was used to record the information. Data analysis was performed using SPSS package for windows version 10.0. Results were compared using Chi-square test by keeping the p-value of <0.05 as significant. RESULTS: Amongst the complications during pregnancy, pregnancy induced hypertension was commonest complication in elderly primigravidas (24.35% vs. 6.41%, p-value < 0.05). Diabetes, malpresentation and premature labour were also more frequent in elderly group (p-value < 0.05). More (30.76%) of elderly group were delivered by caesarean section as compared to 16.02% in young group (p-value < 0.05). Congenital malformations of the fetus were common in elderly group (5.12% vs. 1.28%). Cases of essential hypertension (12.82% vs. 1.92%), fibroid uterus (9.61% vs 2.56%) and ovarian cyst (7.69% vs. 1.92%) were frequent in elderly group patients. Perinatal mortality was relatively high in elderly groups and compared to young patients and 17 babies in elderly group were still born as compared to 10 babies in young group. CONCLUSION: Advanced maternal age has been associated with an increased risk of various complications like hypertension, diabetes, and intrauterine growth retardation and congenital malformations. Timely and accurately diagnosis of complications and their treatment leads to favorable outcome. The higher rate of caesarean section in older primigravidas is due mainly to higher rate of obstetrical complications.

Adult↗
PubMed1997

Obstetric aspects in women with facioscapulohumeral muscular dystrophy, limb-girdle muscular dystrophy, and congenital myopathies.

OBJECTIVE: To increase the knowledge about pregnancy and delivery in women with certain muscle diseases, which is important for obstetric management and family planning of affected women. DESIGN: The obstetric histories of patients with facioscapulohumeral (FSH) muscular dystrophy, limb-girdle (LG) muscular dystrophy, and congenital myopathies (CM) were retrospectively evaluated using questionnaires and medical reports. PATIENTS: The condition of 27 patients with different myopathies (FSH muscular dystrophy, n = 11; LG muscular dystrophy, n = 9; and CM, n = 7 [subdivided into 5 patients with central core disease, 1 patient with cytoplasmic bodies, and 1 patient with unspecified myopathy]) were ascertained from January 1, 1992, to December 31, 1994, through departments of neurology and human genetics, and the German self-support group for muscle diseases. Fifty-eight gestations resulting in 52 live births were reviewed. RESULTS: Miscarriages were reported in 3 of 26 gestations in 11 patients with FSH dystrophy, whereas 3 of 15 pregnancies in patients with LG dystrophy were terminated. Preterm births occurred in 2 patients with FSH dystrophy and in 3 patients with CM. Operative deliveries (vaginal operation or cesarean section) were performed in 6 of 23 gestations in patients with FSH dystrophy (1 emergency section), in 5 of 12 patients with LG dystrophy (2 emergency sections), and in 3 of 17 deliveries in patients with CM. Patients with FSH dystrophy generally coped well with their muscle disease in pregnancy and after delivery; however, 4 women were stated to have difficulties in caring for their families. The situation differed in LG dystrophy, where most women (5 of 9) experienced worsening of weakness in pregnancy and required assistance after delivery. In the patients with CM, 3 women experienced a deterioration during pregnancy, and 4 patients reported difficulties after delivery. CONCLUSIONS: No deleterious outcome of pregnancy and labor was observed in this series of patients with muscular dystrophy or CM, although operative deliveries were more frequent. A significant aggravation of symptoms in gestation is more likely to occur in patients with early-onset and progressive myopathy than in those with stable disease courses.

Adolescent↗
PubMed1984

Transient tachypnea of the newborn. An analysis of neonatal and obstetric risk factors.

Clinical data from 100 neonates with transient tachypnea of the newborn (TTN) and 100 well neonates were compared for the relative incidence of various neonatal and obstetric factors. The incidences of male sex and macrosomia were substantially higher in infants with TTN. Obstetric histories of mothers of neonates with TTN were characterized by longer labor intervals and a higher incidence of failure to progress in labor leading to cesarean delivery. Excessive maternal sedation, perinatal asphyxia, and elective cesarean delivery without preceding labor were not seen more frequently when TTN developed.

Asphyxia Neonatorum↗
PubMed1997

The effect of health maintenance organization vs commercial insurance status on obstetrical management and outcome.

OBJECTIVE: To compare obstetrical management and birth outcomes between patients with health maintenance organization (HMO) insurance and those with private commercial insurance. DESIGN: Retrospective population-based cohort study. SETTING: King County, Washington. PATIENTS: Among newborns delivered in 1992 and 1993, a random sample of 4000 birth records listing HMO insurance for prenatal care was compared with a random sample of 4000 birth records listing private commercial insurance as the primary coverage. MAIN OUTCOME MEASURES: Use of ultrasonography and amniocentesis; rate of primary cesarean section performed; adequacy of prenatal care; incidence of maternal medical complications, low birth weight, and congenital malformations; and length of hospital stay. RESULTS: Women covered by HMO compared with commercial insurance were more likely to undergo ultrasonography (relative risk [RR], 1.4; 95% confidence interval [CI], 1.3-1.4). Inadequate prenatal care was less frequent among HMO-insured patients (RR, 0.6; 95% CI, 0.5-0.7), as was the incidence of birth weight below 2500 g (RR, 0.7; 95% CI, 0.6-0.9). No differences in rates of cesarean section and congenital anomalies were observed. Among women without obstetrical risk factors, HMO-insured mothers were at an increased risk of labor and delivery complications (RR, 1.4; 95% CI, 1.3-1.5); their infants were at an increased risk of infant distress (RR, 1.8; 95% CI, 1.5-2.2). CONCLUSIONS: Patients with HMO insurance have improved access to prenatal care and screening when compared with privately insured patients. The reasons for increased risks of abnormal maternal and infant outcomes observed among a subset of HMO-insured patients are unclear. A study with more detailed prospective data collection is warranted.

Female↗