[Statistical study of the relationship between birth injury and labor presentation in hip dislocation].
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In face of the simplified performance of the mechanical course of birth in the manuals of obstetrics, in reality the conformations of the mechanical course are immense. This we found also in our investigations. But mere an alteration from the classical form of the course of birth is not an indication of intervention. The mechanical course of birth is, however, of much interest for determination of a possible localisation of an injuring mechanism in a brain damaged infant. It should be noticed exactly in the obstetrical journal.
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The electromyogram of the monkey (Macaca fuscata fuscata and Macaca mulatta) uterus in labor presents spike bursts which accompany the rising intrauterine pressure. Asynchronous localized electrical activity develops into synchronous activity during the course of labor. The early postpartum uterus shows an irregular pattern or continuous small bursts of spikes. During labor it responds markedly to prostaglandins (PGs); this declines in postpartum. Direct intrauterine injection of PGF2a is effective in the early postpartum. Intravaginal application of PGE2 (5 mg/kg) in late pregnancy induces regular, frequent bursts of spikes and successful delivery. Electrical activity of the oviduct was not affected by PGs except in early postpartum.
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Fetal heart rates in the range of 100 to 119 beats per minute have been defined as moderate bradycardia. Twenty-five of 1,386 patients monitored during a 1 year period have manifested persistent moderate bradycardia. Moderate bradycardia is apparently related to fetal head compression, often in situations of relative cephalopelvic disproportion. It is alleviated by rotation of the vertex and does not appear to adversely affect the newborn infant.
The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.
The lateral Sims' position was evaluated for routine use in vaginal deliveries. The study demonstrates that delivery in the lateral Sims' position is practical and easily mastered; most easily applied for spontaneous or uncomplicated outlet forceps delivery; of special advantage in breech deliveries, congestive heart failure, hip joint restriction, and leg varicosities; and well accepted by women looking for a less restricted and more natural delivery experience.
The history, physiology, pharmacology, and clinical application of fetal breathing are reviewed. Early optimism that measurements of fetal breathing would aid in perinatal management decisions has remained unfulfilled. Problems to be overcome include standardization of technique and measurement parameters and allowance for physiologic variations. Recent research developments indicate that the likely role of fetal breathing in perinatal medicine will be in conjunction with other established tests of fetal health.