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Uterine position and presentation of minipig-fetuses and their order and presentation at birth.

Uterine position and presentation of fetuses in 17 minipigs during pregnancy were compared with their order and presentation at birth. Fetuses from 1 or both uterine horns were marked between day 80 and day 105 of gestation by 1 or more transuterine injections of either a 2.5% solution of dianil blue (3 animals) or a radiopaque substance (14 animals). Roentgenograms of the newborn pigs, which were ear-notched immediately after birth, enabled making individual identification. Pigs seemed to be delivered randomly from the 2 uterine horns. They either followed a neighbor from the same horn (n = 42) or followed a pig from the contralateral horn (n = 52). Only in 3 dams did 1 uterine horn become empty before delivery from the other horn started. In 4 dams, 1 pig passed its neighbor from the same horn, thereby being born earlier than expected. Moreover, passing of pigs could have occurred and gone undetected in those dams from which the pigs of only 1 horn were marked. This passing might have taken place within the uterine body. From 18 of 95 pigs (19%) , the presentation at birth differed from the one observed at laparotomy.

Animals↗

Perinatal outcome of vaginally delivered twin gestations with a larger twin B.

OBJECTIVE: To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. STUDY DESIGN: Maternal and neonatal charts of live-born, nonanomalous twins, >25 weeks' gestation and vaginally delivered over a period of 17 years were reviewed. The results of this review were distributed among two groups: (1). those with twin B more than 250 g larger than twin A (DeltaBW>250) and (2). those where the difference was <250 g (DeltaBW<250). For vaginally delivered twin gestations, the perinatal outcome of twin B in the group DeltaBW>250 was compared to that of its co-twin, and to that of twin B in the group DeltaBW<250. RESULTS: Of the 679 twin gestations reviewed, 138 (20.6%) were in the group DeltaBW>250, of whom 73 (52.9%) delivered vaginally despite malpresentation in 39.7%. The vaginally delivered twin pregnancies in the groups DeltaBW>250 (n=73) and DeltaBW<250 (n=303) had similar demographics, parity, presentation, gestational age at delivery, and duration of the first stage of labor. Discordant twins were more frequent in the group DeltaBW>250 (26.0 versus 9.5%, p=0.001). Twin B in the group DeltaBW<250 was smaller, with higher incidence of growth restriction, low 5 min Apgar score, and hyperbilirubinemia compared to twin B in the group DeltaBW>250. There was no difference in the incidence of intraventricular hemorrhage, seizures, sepsis, neonatal death, and median nursery stay. Except for a lower median Apgar score at 1 min in twin B and a longer median nursery stay in twin A, twins A and B in the group DeltaBW>250 were similar regarding all other neonatal outcome variables. CONCLUSIONS: When twin B is more than 250 g larger than A, and both are delivered vaginally, the perinatal outcome is similar to its co-twin as well as to that of twin B of all other vaginally delivered twins. That twin B is larger than A is not itself a contraindication to attempted vaginal delivery.

Adult↗

Brow presentation.

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Delivery, Obstetric↗

Neurologic complication of labor analgesia: facts and fiction.

Regional anesthesia has become a hallmark of modern obstetric anesthesia practice and a paramount technique for labor analgesia. Neurologic complications associated with present-day labor analgesia are thought to be unusual; however, they can occasionally complicate peripartum obstetric and anesthetic management of pregnant patients. To date, no review article in obstetric literature has specifically addressed the issue of possible neurologic anesthetic complications attributed to labor analgesia. Therefore, a series of systemic literature searches (Medline) to identify the articles on neurologic complication of labor analgesia was conducted. This review article summarizes the evidence from published articles on this topic, with particular emphasis on the mechanism of neurologic injury, lidocaine-related transient neurologic symptoms, anticoagulation and vascular compromise, diagnostic evaluation, and prevention of neurologic obstetric anesthesia-related neurologic injury in pregnancy.

Analgesia, Obstetrical↗