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[Critical notes on delivery and perinatal mortality in single breech presentation deliveries].

This report deals with 432 single breech presentation deliveries. Caesarean section frequency was 12,3%. As to the vaginal route of delivery, the simple Bracht manoeuvre had been prefered; in recent times, however, the assisted spontaneous delivery with oxytocin-infusion has been introduced. The corrected perinatal mortality was 4,9%. The rate of prematurely born infants amounted to 14,6%. The corrected perinatal mortality of infants up to 2500 g was 3,3%; of full term infants it was 1,4%. The importance of breech presentation delivery as a high risk delivery is being emphasized. Fetal monitoring and blood gas analysis were required. Indications of caesarean section and suggestions for the management of breech presentations were established. Generally caesarean section of primiparae is not recommended. The diminished rate of prematurely born infants is considered to be of great importance for the decrease of perinatal mortality of breech presentation infants. Intensive pregnancy care, widely used uterotocolysis, and cervix-cerclage in cases of breech presentation are recommended.

Birth Weight↗

[Eutocic delivery ].

Delivery is uncomplicated in 60 to 75% of cases. Movement through the pelvic pathway requires precise foetal mobility in relation to the pelvis, since the head must pass using a double rotation: 120 degrees deflection around the symphysis pubis and 45 degrees to 135 degrees rotation around the pelvic cavity, according to the presentation. This mechanism, imposed by the adaptation of the form of the pelvis to the upright position, is possible cue to an apparent reduction in volume of the foetal head by its molding and its flexion. This accommodation is favoured by the maturity of the foetal nervous system, the maturity of the uterus, and by the type of presentation. Anterior presentation (anterior left occipito-iliac), more common in multiparas, is usually safer than posterior presentation (posterior right occipito-iliac). more often seen in primiparas.

Cervix Uteri↗

The reorganization of the nursing labor process: from team to primary nursing.

The author presents a labor process analysis of recent changes in nursing work on hospital wards. In the immediate post-World War II decades, hospital nursing was organized to include stratified nurses--registered and auxiliary nurses (licensed practical nurses and nurses' aides)--in a common labor process called "team nursing." Team nursing adapted Taylorist principles to sharply demarcate tasks between registered nurses (RNs) and auxiliaries. In the 1970s and 1980s, team nursing increasingly replaced by "primary nursing" with a majority of RNs. Auxiliaries were displaced as RNs assumed undivided responsibility for complete nursing care. The transition to primary nursing is partly explained through the convergence of managerial interests with the professionalizing interests of nursing's elite. However, primary nursing was not simply imposed from the top down. Team nursing produced divisiveness between RNs and auxiliaries at the same time that it forced these workers to violate the official differentiation of tasks and held RNs responsible for work performed by auxiliaries. Primary nursing eliminates the problems of team nursing as RNs perform reunified tasks in an unmediated RN-patient relationship. However, primary nursing has produced a new set of contradictions, including an intensified labor process.

Cost Control↗