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PubMed1994

[Amniotic fluid index during labor in women with EPH gestosis].

Intrapartal cardiotocographic disturbances of fetal heart rate patterns, the way of delivery and the neonate state have been analyzed in the group of 61 women in labor with pregnancy complicated by EPH gestosis. The results have been compared with pre-labor values of amniotic fluid index (AFI) in that group. In the group of 30 women in labor with AFI < or = 5 cm the analysis revealed the higher prevalence of non stress test reactivity losses, severe variable decelerations, late decelerations, cesarean sections and lower birth weight in comparison with the group of 31 women in labor with AFI > 5 cm. The study revealed that pre-labor AFI value estimation is usefull in predicting possibilities of fetal compromise during labor in women with pregnancies complicated by EPH gestosis.

Adult↗
PubMed2004

Hypnosis to facilitate uncomplicated birth.

Prior research by the author showed that psychosocial factors distinguished complicated from uncomplicated birth outcome. The purpose of this study was to determine if prenatal hypnosis could facilitate uncomplicated birth. Following a psychosocial assessment, 520 pregnant women in their first or second trimester of pregnancy were randomized to receiving prenatal hypnosis or attention-only groups. The author provided all of the hypnosis in a manner similar to that taught by David Cheek. The goal was to reduce fear of birth and parenthood; to reduce anxiety; to reduce stress; to identify specific fears that might complicate the labor process (addressing them whenever possible); and to prepare women for the experience of labor. The attention-only group was matched to a no-contact comparison group. Women receiving prenatal hypnosis had significantly better outcomes than women who did not. Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to an complicated birth outcome. Attention only was associated with minimal differences in outcome over the no-contact group. The routine prenatal use of hypnosis could improve obstetric outcome.

Adult↗
PubMed2004

Risk factors and outcomes associated with a short umbilical cord.

OBJECTIVE: To identify risk factors and outcomes associated with a short umbilical cord. METHODS: We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord. Controls (n = 14260) were randomly selected from among births without a diagnosis of short umbilical cord. RESULTS: Case mothers were less likely to be overweight (body mass index 25 or more, odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6, 0.8) and more likely to be primiparous (OR 1.4; 95% CI 1.3, 1.6). Case infants were more likely to be female (OR 1.3; 95% CI 1.2, 1.4), have a congenital malformation (OR 1.6; 95% CI 1.4, 1.8), and be small for their gestational age (risk ratio [RR] 1.6; 95% CI 1.4, 1.9). A short cord was associated with increased risk for maternal labor and delivery complications, including retained placenta (RR 1.6; 95% CI 1.2, 2.3) and operative vaginal delivery (RR 1.4; 95% CI 1.3, 1.5). Adverse fetal and infant outcomes in cases included fetal distress (RR 1.8; 95% CI 1.6, 2.1) and death within the first year of life among term infants (RR 2.4; 95% CI 1.2, 4.6). CONCLUSION: Modifiable risk factors associated with the development of a short cord were not identified. Case mothers and infants are more likely to experience labor and delivery complications. Term case infants had a 2-fold increased risk of death, which suggests closer postpartum monitoring of these infants.

Adult↗
PubMedDate not supplied

Liver rupture postpartum associated with preeclampsia and HELLP syndrome.

Liver rupture is a rare perinatal complication with high maternal mortality. In a multiparous woman with preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome, liver rupture was suspected 10 h after a cesarean section. Laparotomy revealed liver rupture which was treated by perihepatic packing. Eventually, the mother was discharged with her baby 88 days after admission. Clinical symptoms, maternal hemodynamics by Swan-Ganz monitoring, and laboratory findings were not predictive until the emergency situation and the consecutive complications required multidisciplinary management.

Adult↗
PubMed2003

Elective cesarean delivery for term breech.

OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery. CONCLUSION: Elective cesarean delivery for term breech carries a low risk of severe maternal complications.

Adult↗
PubMed2000

Obstetric factors, urbanization and psychosis.

BACKGROUND: Epidemiologic evidence as early as the 1930s has suggested urbanization is linked to schizophrenia, either by place of admission, place of upbringing, or, more recently, place of birth. In the past decade, obstetric complications have been implicated in the etiology of schizophrenia. METHODS: With appropriate protections for anonymity, the files of the Danish Medical Birth Register were linked with the files of the Danish Psychiatric Case Register. The linkage produced 132 cases of schizophrenia and 69 cases of affective psychosis, who were born in 1973 or later, who entered a Danish psychiatric hospital before 1994. Controls were drawn from a 10% sample of the Medical Birth Register. Analysis was by logistic regression. RESULTS: The risk of hospitalization for schizophrenia was 4.20 times higher (95% CI=2.4-7.4) for those born in Copenhagen versus those born in rural areas of Denmark, and a linear relationship was demonstrated between urbanization of birthplace and risk. There was no difference in risk of hospitalization for affective psychosis for those born in Copenhagen versus rural areas. Obstetric complications had a moderate sized relationship to schizophrenia, but the relationship of urban birth to schizophrenia was unaffected by adjustment for obstetric complications. CONCLUSION: Urban birth is a strong risk factor for schizophrenia, not mediated by obstetric complications, which deserves further exploration.

Adult↗
PubMed1988

Variations in anxiety levels during pregnancy and psychosocial factors in relation to obstetric complications.

Patterns of variation of state and trait anxiety during pregnancy and after delivery were studied prospectively in relation to some obstetrical and neonatal disturbances. Specific pregnancy anxiety, social support, and coping style were also evaluated. State anxiety in the 3rd month was significantly higher among women with obstetric complications and oscillated during the course of pregnancy, with significantly higher levels in the 3rd and 9th months. No such variations were found in the women with uncomplicated pregnancies. None of the other psychosocial variables examined were related to complications.

Adaptation, Psychological↗
PubMed1984

Cerebral ventricular enlargement in non-genetic schizophrenia: a controlled twin study.

In a group of schizophrenics of twin birth, no evidence of ventricular enlargement was found where there was a family history of major psychiatric disorder. Among those schizophrenics without such a family history, cerebral ventricular size was significantly increased (P less than 0.01), and there was also evidence of birth complications. Among normal control twins, those who reported complicated births had significantly larger ventricles.

Adult↗
PubMed1981

The influence of cord complications on fetal pH, neonatal Apgar score, and the acid base state and oxygenation of the umbilical artery and vein.

Continuous monitoring of fetal scalp tissue pH (tpH), acid base and oxygenation measurements of the blood of the umbilical artery and vein, and APGAR scoring was performed in 152 deliveries. The effect of cord complication on tpH (120, 90, 60, 30, 15, 10, 5, and 0 minutes before delivery), the status of the umbilical artery and vein (pH, pCO2, base excess, standard bicarbonate, pO2, and oxygen saturation), and the APGAR scores (one and five minutes after delivery) were investigated. Thirty-two per cent of the deliveries were associated with on or more cord complication(s). Cord complications in general did not influence the APGAR scores, the acid base state, or the oxygenation of the fetus and newborn. In the very few cases of tight cord complication(s) tpH showed a marked decrease during the last 30 minutes of labour, the umbilical blood was slightly acidotic, but the APGAR scores were normal (8-10 one and five minutes after delivery). No cases of prolapse of the cord were found. Cord complications are very common but in most cases completely harmless.

Acid-Base Equilibrium↗
PubMed1983

Antenatal education: does it improve the quality of labour and delivery?

Of 196 nulliparous women who delivered in a two month period, 78 percent had attended antenatal education classes. The mothers who did not attend antenatal classes consisted of significantly more Maori and Pacific Island mothers, they were younger, smoked more, had a lower socioeconomic status and fewer were married. The group who went to antenatal education classes had a significantly longer second stage in labour and required more forceps assistance during delivery compared to non-attenders. These results remained for the polynesian mothers, when they were analysed separately and the differences in age and socioeconomic status were no longer present. There was no difference in the type of pain relief required during childbirth by the attenders or non-attenders. We found no evidence that attending antenatal education classes will ensure an easy and less complicated childbirth.

Age Factors↗
PubMed1978

[Gastro-duodenal ulcers with pregnancy. Condition of shock in labour due to intestinal haemorrhage from an ulcer (author's transl)].

We present the case of a multiparous woman of 32 years of age who, at term after a more or less normal pregnancy, went into severe shock in labour. The patient in this case was very difficult to diagnose. Her life was only saved after massive blood transfusions and after delivering a fresh stillborn infant. It was not a case of uterine rupture nor of retro-placental haemorrhage. The site of origin of the hypovolaemic shock was intestinal. The patient had an ulcer of the pylorus which was diagnosed after fibroscopy. Some authors state that it appears that the few ulcers that have been diagnosed before pregnancy go into remission during pregnancy. All the same it would appear that sometimes very serious complicated ulcers which have to be treated with great respect do occur, especially in toxaemic patients at the end of pregnancy, and these carry with them a significant mortality both for the mother and the fetus. Although medical treatment (resuscitation) is essential, surgery should be resorted to if necessary because it may save the mother and sometimes the infant and so improve the prognosis of complicated ulcers occurring in pregnancy.

Adult↗
PubMed1996

Critical management of the very low birth weight infant and macrosomic fetus.

The two extremes of birth weight ( < 1500 g and > 4000 g) require antepartum surveillance and anticipation of complications during labor and delivery. Prognosis for the very low birth weight carries with it inherent neurologic impairment even when cared for under the best of conditions. In contrast, the macrosomic fetus enjoys a generally excellent outcome regardless of management. The current concern is too much intervention to avoid a low probability of complications.

Delivery, Obstetric↗