Epidural anesthesia for delivery complicated by benign intracranial hypertension.
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Adult↗
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Delivery complicated by myasthenia gravis and epilepsy.
The literature on the possible risk of myasthenia gravis complicating pregnancy and delivery is sparse and partly contradictory but some of the reports on the number of perinatal and neonatal deaths are alarming. Epilepsy in pregnancy implies on approximately twofold risk of intervention in connection with labour. A pregnant patient with myasthenia gravis and epilepsy has recently been delivered. The case is reported and the considerations with regard to suitable anaesthesia and the two diseases are discussed.
Adult↗
[Study of fetal heart rate in deliveries complicated by fetal acidosis].
A study has been carried out on the parameters of the graph of the fetal heart rate (the basal rate and dips) in 44 cases of acute fetal distress with a pH lower than 7.2 in the blood and in 30 normal deliveries. The statistical analysis confirms that there is a significant rise in the number of heart rate abnormalities such as persistent bradycardia or persistent tachycardia and with dips during deliveries with fetal acidosis. The frequency of these abnormalities increases with the degree of acidosis. Sometimes the abnormalities in the fetal heart rate precede the appearance of the acidosis. All the same the discovery of these abnormalities does not by itself make a precise diagnosis of fetal distress because we do find these abnormalities in a certain number of cases even in normal deliveries. Only measuring fetal pH at a definite time can establish the diagnosis of fetal distress and the severity of the condition.
Acidosis↗
Pregnancy complications following legally induced abortion.
The frequency of pregnancy and delivery complications in women whose previous pregnancy had been terminated by a legally induced abortion is evaluated in a prospective and a retrospective study. Bleeding before 28 weeks of gestation and retention of placenta or placental tissue occurred more frequently after legal abortion that in a control group matched for age, parity, and socio-economic status. Other pregnancy and delivery complications did not occur more frequently after legal abortion. It is of particular interest that the study could not demonstrate an increased frequency of low birth weight among women whose previous pregnancy had been terminated by legal abortion.
Abortion, Induced↗
Adult third ventricle width and infant behavioral arousal in groups at high and low risk for schizophrenia.
Previous research has demonstrated: (1) Subjects who are at genetic high risk for schizophrenia and who suffer delivery complications are at increased risk to evidence a widened third ventricle. (2) A widened third ventricle is related to decreased ANS arousal and, among schizophrenics, is related to negative symptom schizophrenia. (3) Adult schizophrenics evidence behavioral analogues of negative symptom schizophrenia premorbidly. This study compared adult CT scans to ratings of infant behavior in 179 subjects (104 at high genetic risk for schizophrenia) with the hypothesis that widened third ventricles would be related to underaroused infant behavior. Results of an ANOVA suggest that subjects who are at genetic high risk for schizophrenia and who evidence a widened third ventricle are more likely to have shown signs of behavioral underarousal as infants. Possible explanations, implications and limitations of the study are discussed.
Adolescent↗
Aneurysmal subarachnoid hemorrhage care in a middle-income public healthcare system: A real-world neurocritical care cohort.
BACKGROUND AND PURPOSE: Although aneurysm treatment capacity has expanded worldwide, outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain strongly influenced by neurocritical care (NCC) delivery, referral pathways, and access to specialized treatment. Contemporary data describing real-world aSAH care in resource-limited healthcare systems remain scarce. We aimed to characterize treatment patterns, NCC delivery, complications, and outcomes in a large Brazilian public referral center. METHODS: This retrospective cohort study included consecutive adults with confirmed aSAH admitted between June 2018 and March 2022 to a high-volume Brazilian tertiary referral center. Only patients admitted within five days of symptom onset were included. Demographic, clinical, radiological, treatment, complication, and outcome data were extracted from institutional records. Primary outcomes were in-hospital mortality and 3-month functional outcome assessed by the modified Rankin Scale (mRS). RESULTS: Seventy-four patients were included. Disease severity was high, with 45% presenting WFNS grades 4-5, 73% modified Fisher grade 4 hemorrhage, and 64% hydrocephalus. Endovascular treatment was performed in 73% of cases, and median time from admission to aneurysm treatment was 1 day. Despite early treatment capability, only 28% of patients were admitted to an ICU within 48 h, while 38% never received ICU care. Delayed cerebral ischemia occurred in 43%, radiologic vasospasm in 58%, ventriculitis in 22%, and infectious complications in 57%. External ventricular drainage was required in 42%, and vasoactive drugs were used in 85%. In-hospital mortality was 42%, and 66% had unfavorable 3-month outcomes (mRS 4-6). CONCLUSIONS: This real-world cohort highlights the substantial neurocritical care burden of aSAH in a middle-income public healthcare system. Despite timely access to definitive aneurysm treatment, patients experienced frequent neurological and systemic complications, emphasizing that contemporary aSAH care extends well beyond aneurysm occlusion.
Humans↗
McRoberts maneuver for the management of the aftercoming head in breech delivery.
A case report of breech delivery complicated by entrapment of the aftercoming head is presented. McRoberts maneuver was applied to facilitate the release of the head. It is suggested that the same theoretical basis that stands behind the use of McRoberts maneuver in shoulder dystocia might make it applicable as one of the maneuvers to release the aftercoming head in breech delivery.
Adult↗
Cyproheptadine in anorexia nervosa.
In three hospitals 81 female patients satisfying rigorous diagnostic criteria for anorexia nervosa were randomly allocated to one of four treatment combinations of cyproheptadine and placebo with behaviour therapy and no behaviour therapy. Cyproheptadine was found to be effective in inducing weight gain in a subgroup of anorexia nervosa patients who (a) had a history of birth delivery complications, (b) had lost 41-52 per cent weight from norm and (c) had a history of prior outpatient treatment failure. This subgroup may represent a more severe form of anorexia nervosa.
Ambulatory Care↗
Pretreatment predictors of outcome in anorexia nervosa.
The relationship of selected pretreatment characteristics to weight gain during treatment was examined in 81 anorexia nervosa patients. Good prognostic indicators correlating positively with weight gain were: no previous hospitalizations for anorexia nervosa, a great amount of overactivity before treatment, less denial of illness, less psychosexual immaturity and the admission to feeling hunger. A perinatal history of delivery complications was associated with the poor outcome predictor of prior hospitalizations.
Adolescent↗
Pregnancy complications following legally induced abortion with special reference to abortion technique.
A study of 576 pregnant women, whose previous pregnancy had been terminated by legally induced abortion, has shown that the rate of pregnancy and delivery complications could not be correlated with the interval between the abortion and the subsequent pregnancy, nor with the gestational age at the time of abortion, nor the number of previous induced abortions. Neither was the abortion technique found to correlate with the frequency of complications in a subsequent pregnancy. It was found, however, that more infants with a birth weight below 2 501 grams were born to women whose cervical canal during abortion had been dilated more than 12 mm, and by women who had been submitted to récurettage. The latter group also demonstrated a higher frequency of retained placenta or placental tissue.
Abortion, Induced↗
Pregnancy complications following conization of the uterine cervix (II).
The effect of conization upon the course of pregnancy and the fertility has been evaluated. 44 women had a total of 66 pregnancies following conization. These 44 women were compared with an age-matched group of non-conized women, as well as with a group of non-conized women matched for both age and parity. There were more smokers among conized than among non-conized women. All other descriptive variables were found to be without significant differences between the groups compared. There was no significant difference in the frequency of spontaneous and induced abortion, prematurity or cesarean section between conized and non-conized women. The second stage of labor was found to be protracted in conized women. Fertility judged by the "latent period"--the time elapsed from the couple started sexual intercourse without use of contraception to the present pregnancy--showed no difference between conized and non-conized women. We conclude that although a greater number of patients is necessary to permit definite conclusions concerning the risk of pregnancy and delivery complications in conized women, it is of special interest that the present study did not demonstrate an increased risk of spontaneous abortion nor of prematurity.
Abortion, Spontaneous↗
Method of delivery and developmental outcome at five years of age.
A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.
Cesarean Section↗
[Influence of age on risk-factors during pregnancy, delivery and puerperium of primiparae (author's transl)].
The course of pregnancy and delivery of 600 primiparae is being reported. These were divided into four age groups: very young primiparae (14-16 years of age, Group I), older primiparae (35-39 years of age, Group III) and old primiparae (40 years and more, Group IV). These age groups are being compared to a collective of primiparae, by whom the delivery took place at an age between 17 and 34 years (Group II). In these age groups the difference in complication rate during pregnancy, delivery and puerperium is demonstrated. The differences were statistically secured by means of X-2-test. The very young primipara shows the least tendency to delivery complications, still her pregnancy should be considered more risky as compared to Group II, owing to the higher rate of gestosis and the tendency to premature delivery. Groups III and IV show a rising risk rate with increasing age in regard to gestosis (10, 8-30, 8%) and premature delivery (15, 4-28, 6%); also the higher rate of operational delivery was significant (38, 9-44, 6%). The highest risk rate is to be expected in women, who deliver the first time at an age above 40 years. Also the perinatal mortality of newborn is at its highest in this group.
Adolescent↗
Pregnancy outcome and infant development following gestational cocaine use by social cocaine users in Toronto, Canada.
To determine the effect of first trimester cocaine use on pregnancy outcome we conducted a prospective cohort study of 30 women admitting to social cocaine use (SCU) during early pregnancy, 20 users of cannabis during the first trimester and 30 matched recreational drug-free control subjects. The groups were of similar age, marital status, and obstetric history and were predominantly white. They were of similar socioeconomic status (SES), however the spouses of the cocaine users were of significantly lower SES than those of both control groups (p less than 0.005). The number of years of education of the cocaine users and the fathers of the SCU-exposed fetuses was significantly lower than that of the recreational drug-free control subjects (p = 0.004), however, female IQ was similar among the three groups (109.1 +/- 12.4 cocaine; 109.1 +/- 25.2 cannabis; 114.1 +/- 11.7 drug-free). Alcohol and cigarette use was greater among the cocaine users than among subjects of the recreational drug-free control group (p less than 0.025). Cocaine and the associated lifestyle were not associated with any adverse obstetric or neonatal endpoint (pregnancy weight gain, incidence of delivery complications, gestational age, birth weight, Apgar scores, and rates of major and minor malformations). There were no differences between groups in attaining developmental milestones. Mental and motor scores on the Bayley Scales of Infant Development and Vineland Adaptive Behavior Scales were identical among the three groups, studied at a mean of 19.7 months of age. We conclude that outcome of pregnancy of social cocaine users and subsequent infant physical and cognitive development are within normal limits at 1.6 years of age.
Adolescent↗
[Antenatal surveillance and risks of prematurity and fetal growth retardation].
The essential aim of this work was to investigate the relationship between antenatal care and preterm delivery or low birth weight. This study has been done by means of a case-control survey carried out among 435 women who delivered in 4 Maternity Hospitals in Aix-en-Provence-Pertuis area, between November 20th, 1987 and September 30th, 1988. Cases consisted of 124 women having delivered single livebirths before 37 weeks' gestation and 69 women having delivered, at term, single livebirths weighting less than 2,500 g. Controls were 242 women who delivered normal single livebirths. Results showed that, within the geographic area of the study, low birth weight and preterm delivery rates were respectively 6% and 5.4%. Antenatal care was generally according to medical profession recommendations: average number of visits: 7.9; first visit achieved, for 98.8% of women, within first trimester; intervention of a specialist in 97.1% of pregnancies; average number of ultrasound examinations: 3.5. Only mothers of low birthweight infants had more often an inadequate antenatal care (OR = 2.63, 95% confidence interval: 1.22-5.70). The risk factors for low birth weight were: previous history of preterm and/or low birth weight delivery, single marital status, low lever father's education, smoking during pregnancy, no contact with maternity team and for preterm delivery: previous history of preterm and/or low birth weight delivery, complications during the penultimate pregnancy, hypertension, metrorragies. These results suggest that it seems unlikely, in the future, to decrease unfavorable pregnancy outcomes by increasing antenatal care.
Case-Control Studies↗
Congenital mesoblastic nephroma and polyhydramnios.
Polyhydramnios and premature delivery complicated the pregnancies of three women whose infants were born with renal tumors. In each case the tumor was a mesoblastic nephroma. The liquid of polyhydramnios enhances detection of masses in the fetal abdomen by ultrasound. In the future, mesoblastic nephroma may, therefore, be diagnosed antenatally. Tumors in these infants, which have proved in most cases to be benign, are usually cured by surgical removal. Occasionally, local infiltration and adhesions prevent removal. The fate of the infant with residual tumor is not known.
Adult↗
Catecholamines in fetal blood during birth in man.
Catecholamines and pH were determined simultaneously in human fetal scalp blood during parturition and in umbilical artery blood at birth. During the course of six normal vaginal deliveries with relatively small changes in blood pH about a ten-fold increase in catecholamine concentration was found. During six deliveries complicated by falls in blood pH to < 7.25 much higher values were often encountered.
Epinephrine↗
[Premature rupture of fetal membranes and intra-amnionic infection].
Although the group under study was small (90 cases) but compared with the control group of the same size it did reveal some facts: 1. The duration of labour was much shorter (by 8 hours on the average) in the control than in the study group. 2. The result of the assessment of the condition of children by the Apgar score was somewhat better in the control group, which is understandable with regard to the subsequent delivery course in the group of children with a premature bursting of the bag of waters. 3. The percentage of directed labour in the group under study was significantly higher (60%). 4. Surgical completion of labour in the study group (10%) was more frequent than in the control group (4.4%). Breech presentation was observed only in the study group (5.5%) which corroborates the old rule that in any premature bursting of the bag of waters, along with all kinds of delivery complications, also the cephalopelvic disproportion and some irregular presentation of the fetus in labour should be expected. 5. Although in the premature bursting of the bag of waters the duration of labour is longer (14 hours and 19 minutes) than in the control group (5 hours and 40 minutes), no more frequent infection, either in newborns or mothers, has been observed.
Adolescent↗