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At least 1,711 records · Page 95Linked to original sources
PubMed2003

Social drug use in the parturient: implications for the management of obstetrical anaesthesia.

Maternal use of social drugs in pregnancy continues to increase--worldwide. Although a great deal has been learned regarding the implications of illicit drug abuse in pregnancy (cocaine, amphetamines, hallucinogens), the use of social drug in pregnancy has received far less attention. This article reviews the consequences of the social drug use in pregnancy including ethanol, tobacco and caffeine and offers recommendation for anaesthetic management of these potentially complicated pregnancies.

Female↗
PubMed1989

[The course of delivery in a group a low-risk primipara women].

The course of delivery in 1,545 primiparae who were considered to be in the low-risk group at the commencement of labour as assessed by the previous directives issued by the Danish Ministry of Health (1976) were reviewed. 2/3 were delivered normally as episiotomy was not regarded as a complication. 1/3 had complicated deliveries. In 350, the contractions were abnormal and intervention was required. 1/3 of these were delivered instrumentally. Haemorrhage of more than 500 ml, intrauterine asphyxia and Apgar score less than or equal to 7 at 1 minute occurred frequently in this group. A total of 1,195 did not receive treatment to improve contractions and, in this group, instrumental delivery was undertaken in 10%. Following normal labour pains and spontaneous delivery, complications in the third stage were observed in 77 out of 1,075 patients, including haemorrhage of more than 500 ml in 38 patients. Six infants in this group had Apgar scores less than or equal to 7 at 5 minutes. In the group with abnormal contractions and/or instrumental delivery, haemorrhage of more than 500 ml, retention of the placenta and signs of perinatal asphyxia occurred, however, significantly more frequently. The authors consider that home deliveries in primiparae cannot be recommended. Primiparae should be advised to be delivered in hospital as it is not always possible to predict complications.

Adolescent↗
PubMed1983

Prolactin-producing microadenomas in pregnancy.

Fifty-four patients with evidence of a prolactin-producing pituitary microadenoma were followed through pregnancy. Obstetric complications included four spontaneous abortions, one stillbirth, and one premature delivery. Four patients developed visual defects (two with abnormal visual fields). Four patients noted headaches. The progressive rise in maternal prolactin levels seen in a control group was not seen in the prolactinoma patients. In the tumor patients, maternal prolactin levels were already elevated early in pregnancy and did not increase further. Maternal prolactin levels were not predictive of any complications. The present study suggests that pregnancy is safe in microadenoma patients and that the few complications encountered are highly amenable to appropriate management.

Adenoma↗
PubMed1994

Intracutaneous sterile water for back pain in labour.

Intracutaneous sterile water appears to be a simple, effective, and harmless technique for relieving back pain. This technique has been used to relieve pain of renal colic, whiplash, and back pain in labour. Family doctors often practise obstetrics in small or isolated units that have limited options for pain relief in labour. This technique is simple, is easy to learn, and appears effective for relieving back pain, which complicates about one third of all labours.

Anesthesia, Obstetrical↗
PubMed2005

Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?

OBJECTIVE: This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. STUDY DESIGN: We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. RESULTS: The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). CONCLUSION: The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who attempt VBAC relative to elective repeat cesarean delivery, the absolute risk of major complications remains low.

Adult↗
PubMed2004

Induction of labor after one prior cesarean: predictors of vaginal delivery.

OBJECTIVE: To estimate the characteristics most associated with vaginal birth in patients undergoing induction of labor after 1 prior cesarean delivery. METHODS: All patients who presented for induction of labor from 1996 to 2001 with a history of 1 prior cesarean delivery were identified. Relevant demographic and obstetric data were abstracted from the charts. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean. Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. RESULTS: Of the 429 women included in the study, 334 (77.9%) had a successful trial of labor. In the final binary logistic regression equation, prior vaginal delivery (odds ratio [OR] 3.75; 95% confidence interval [CI] 1.96, 7.18) remained independently associated with an increased chance of a vaginal delivery after a trial of labor. Conversely, prior cesarean delivery for dystocia (OR 0.46; 95% CI 0.27, 0.79), induction on or past the estimated date of delivery (OR 0.46; 95% CI 0.27, 0.78), need for cervical ripening (OR 0.35; 95% CI 0.20, 0.61), and maternal gestational or preexisting diabetes (OR 0.16; 95% CI 0.06, 0.40) were all factors associated with a decreased likelihood of achieving a successful trial of labor. CONCLUSION: Several factors are available which may assist in identifying patients with the best chance of vaginal delivery after an induction of labor in the presence of a prior low-transverse cesarean scar. LEVEL OF EVIDENCE: II-2

Adult↗
PubMedDate not supplied

Caesareans and low-risk women in Israel.

Randomised retrospective study of the rise in caesarean surgery among low-risk women between 1990 and 2000 at Hadassah Ein Kerem Labor and Delivery Unit in Jerusalem. The CS rate in low-risk women increased from 4 per cent to 10.5 per cent. Approximately 90 per cent of the population was low risk.

Adult↗
PubMed2004

[The corse of pregnancy and delivery in patients with surgicaly corrected tetralogy of Fallot].

Twenty-eight pregnancies in 16 patients with surgically corrected tetralogy of Fallot between 1997 and 2002 at the SBALAG "Maichin dom", Sofia, were reviewed. Most of the patients were well and asymptomatic after surgery, excluding one patient who was functional class III. The patients had a total of twenty-one successful pregnancies and deliveries. There were seven abortions (33%) and two small-for-date babies (12%). None of the infants had any cardiac anomalies. The pregnancies were relatively well tolerated and there were no life-threatening cardiac complications. For a patient with some residual abnormalities after surgical correction of tetralogy of Fallot, it is important to reassess the cardiac state before pregnancy and, if once pregnant, to anticipate the possible occurrence of complications during labor. Compared to the general obstetric population, more women in the study group underwent instrumental vaginal delivery and probably best option was elective ventouse or forceps. In conclusion despite potential difficulties and complications associated with corrected tetralogy of Fallot, careful cardiac and obstetric management resulted in good maternal and fetal outcomes.

Adolescent↗
PubMed1994

Assessment of computed tomographic pelvimetry within a selective breech presentation management protocol.

A vital component of selective protocols in term breech presentation management is exclusion of the gravida with borderline pelvic dimensions. Computed tomographic (CT) pelvimetry was employed to evaluate potential candidates for a trial of labor with a breech fetus at term. Thirty-seven of 39 women who underwent labor after this selection had a successful assisted vaginal breech delivery. Adequate pelvic dimensions by CT pelvimetry reliably predicted a safe vaginal delivery in patients managed within a standard breech protocol.

Breech Presentation↗
PubMed1993

Vaginal birth after cesarean section. Acceptance and outcome at a rural hospital.

A retrospective review of all pregnant women with a history of cesarean section was conducted at an isolated military hospital. During the two-year period 1988-1989, 62 patients were initially considered eligible for attempting vaginal birth after cesarean section (VBAC). Seventy-nine percent (49/62) of the patients initially requested a trial of labor, and 14 of them ultimately did not meet American College of Obstetricians and Gynecologists criteria. Three patients reversed their decision late in pregnancy. Eighty-eight percent (28/32) of those undergoing a trial of labor delivered vaginally. The three patients with more than one prior cesarean section all delivered vaginally. The four failures occurred in patients who had a history of well-documented cephalopelvic disproportion. Perinatal morbidity consisted of intrauterine fetal demise prior to the onset of labor at 40 weeks' gestation. Maternal morbidity included postcesarean endometritis (n = 1) and vaginal sidewall laceration (n = 1). These results indicate that in a rural hospital VBAC was well accepted by patients and was safe; however, further study is required.

Decision Making↗