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At least 19 recordsLinked to original sources
PubMed1997

A study of gamma-aminobutyric acid (GABA) in amniotic fluid.

OBJECTIVE: The purpose of the study was to evaluate the role of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, in amniotic fluid (AF) during fetal distress, because it has been reported that several neurotransmitters, e.g. norepinephrine, are affected by GABA. METHODS: AF was obtained during elective cesarean section (CS, n = 11) and cesarean section due to fetal distress without labor pain (FD, n = 7). Maternal and umbilical-cord blood, as well as the first urine of the neonates, also were collected. GABA, norepinephrine (NE), and epinephrine (EP) concentrations were measured using HPLC. RESULTS: The GABA concentration was higher in the AF than in either maternal or fetal circulation, or in the first urine of neonates. The GABA concentrations in the AF and in the first urine of neonates were significantly higher in the FD group than in the CS group (p < 0.05). Furthermore, significant positive correlations were observed between the NE and GABA concentrations and between the EP and GABA concentrations in the AF. GABA was produced in a time-dependent manner in cultured amnion cells. CONCLUSION: The highest concentration of GABA was found in the AF. The GABA in the AF appeared to be derived from both the amniotic membrane and the fetal urine. The increase in the GABA concentration in cases of fetal distress might be partially derived from the fetus via fetal urine. The positive correlations between the concentrations of GABA and those of NE and EP in the AF, suggest that GABA, NE, and EP might play important roles during fetal distress.

Adrenergic alpha-Agonists↗
PubMed1996

A study of monoamine oxidase activity in fetal membranes.

OBJECTIVE: To study the role of decidual monoamine oxidase (MAO)-A and -B activities before delivery, the relationship between MAO activity in fetal membranes and catecholamine (CA) concentration in amniotic fluid (AF) was determined. METHODS: Fetal membranes and AF were obtained at the time of elective Cesarean section (CS group, n = 11) and Cesarean section due to fetal distress without labor pains (FD group, n = 5). MAO-A and -B activities were radiometrically measured using 14C-5-hydroxytriptamine for MAO-A substrate and 14C-benzylamine for MAO-B substrate. CA concentrations in AF were measured by high performance liquid chromatograph with an electro-chemical detector. RESULTS: Both MAO-A and -B activities in decidua obtained from CS were significantly lower than those obtained from FD. Both norepinephrine (NE) and epinephrine (EP) concentrations were significantly lower in the CS group than the FD group. A significant positive correlation between decidual MAO-A activity and NE concentration in AF was observed. No significant correlation was observed between MAO-B activity and the concentration of NE in AF. There was no correlation between EP concentrations and MAO activities. CONCLUSION: These results suggest that CA concentration in AF may be related to the activity of MAO in fetal membranes, determined by certain physiological processes during pregnancy. It has been suggested that metabolism of monoamines in fetal membranes also plays an important role in reducing monoamine influx into maternal myometrium from the AF.

Adult↗
PubMed1999

Thickness of the lower uterine segment: its influence in the management of patients with previous cesarean sections.

OBJECTIVE: To determine how ultrasound measurement of the lower uterine segment affects the decision about delivery for patients with previous cesarean sections (CS) and what are the consequences on cesarean section rates and uterine rupture or dehiscence. DESIGN: Prospective open study. PATIENTS: 198 patients: all women with a previous CS who gave birth in our department during 1995 and 1996 to an infant with a gestational age of at least 36 weeks and who underwent ultrasound measurement of their lower uterine segment (95-96 study group), compared with a similar population from 1989 to 1994 whose measurements were not provided to the treating obstetrician. RESULTS: Among the patients with one previous CS, the vaginal delivery rate did not differ significantly during the two periods (70.3% for the 89-94 study period vs. 67.9% for the 95-96 study period, P=0.53), but the 95-96 study group experienced a significant increase in the rate of elective CS, compensated by a reduction in the rate of emergency CS (6.3% and 23.4%, respectively, for the 89-94 study period vs. 11.9% and 20.1% for the 95-96 study period, P=0.01). There was a very significant increase in the rate of vaginal delivery for the 95-96 study period among patients with two previous CS (26.7% vs. 8.0% for the 89-95 study period, P=0.01). The lower uterine segment was significantly thicker among women with a trial of labor than among those with an elective CS (4.5+/-1.4 mm compared with 3.8 +/- 1.5 mm; P=0.006); and the trial of labor group contained significantly fewer women with a lower uterine segment measurement less than 3.5 mm than did the elective CS group (24.0% compared with 56.6%; P<0.001). Two patients (0.8%) were found to have a defect of the uterine scar, a rate significantly lower than that observed in the early group (3.9%, P=0.03). CONCLUSIONS: Ultrasound measurement of the lower uterine segment can increase the safe use of trial of labor, because it provides an additional element for assessing the risk of uterine rupture.

Adult↗
PubMed1996

Perinatal mortality and case fatality after placental abruption in Norway 1967-1991.

STUDY OBJECTIVE: To study national secular trends in Norway of perinatal mortality and case fatality to placental abruption (PA) and associations with cesarean section (CS). DESIGN: A population based cohort study. SETTING: The Medical Birth Registry of Norway. PATIENTS: 9,592 cases of placental abruption (PA) of a total of 1,446,154 births notified in Norway 1967-1991. MAIN MEASURES: Comprehensive perinatal mortality (all stillbirths > or = 16 weeks of gestation and early neonatal deaths) and standard perinatal mortality (all stillbirths > or = 28 weeks of gestation and all early neonatal deaths). Case fatality rate. MAIN RESULTS: From 1967 through 1991, the standard perinatal mortality rate due to placental abruption (PA) in Norway decreased from 2.5 per 1000 births (13.5% of all deaths) in 1967 to 0.9 (13.2%) in 1991. The comprehensive perinatal mortality rate due to placental abruption (PA) in Norway decreased from 3.2 to 1.7 per 1000. The proportion of all perinatal deaths due to PA increased from 11.4% in 1967-1971 to 217.0 in 1987-91 and decreased in all gestational age categories. Case fatality in PA with cesarean section (CS) was generally lower than in PA without CS, regardless of gestational age. CONCLUSIONS: Placental abruption is an important cause of perinatal mortality in Norway. Our results are in favor of an active approach with frequent use of cesarean section, also at lower gestational ages. The decreasing case fatality rate by year of birth in all gestational age groups may be attributed to improved obstetric and perinatal care.

Abruptio Placentae↗
PubMed1989

[Labor induction and stimulation after a prior cesarean section].

The author thinks that oxytocin induction and stimulation should be used more freely under proper conditions: high pelvic score, lack of pelvic-fetal disproportion. Oxytocin induction and stimulation was used in 72 parturients out of 241 parturients, who delivered vaginally after cesarean section (CS). The risk of the parturient with preceding cesarean section, undergoing oxytocin infusion, ia not greater than that, which exists in each parturient after preceding CS and good clinical choice and dynamic observation. This correlates with literary data, indicated by the author, as well.

Bulgaria↗
PubMed1989

Maternal, amniotic fluid and cord blood metabolic profile in normal pregnant and gestational diabetics during recurrent withholding of food.

In order to advise regarding the religious practice of withholding food, we studied the metabolic changes after successive 15 days of recurrent fasting of 13 hours every day in maternal plasma and liquor amnii of obese normal gravids and gestational diabetics in their third trimester. There were no significant differences between those who fasted that period for one day prior to elective cesarean section (CS) and those who fasted the same period repeatedly for 15 days. The fasted gravids had significant rises in glycerol, beta-hydroxybutyrate (BOHB) and nonesterified fatty acids (NEFA) (P less than 0.0001, P less than 0.005 and P less than 0.01, respectively) in maternal plasma, compared to unfasted gravid groups and ungravid fasted group. No significant metabolic difference was found in the liquor amnii withdrawn from fasted and unfasted groups. The influence of such short term of starvation on the fetal metabolic profile was studied in the cord blood during cesarean section (CS). Glucose, glycerol and NEFA were significantly lower in arterial than in venous cord plasma (P less than 0.05, P less than 0.01 and P less than 0.01, respectively) indicating that the fetus could utilize these substrates. Positive correlation was found between the levels of BOHB in the mother and venous cord plasma on the one hand and their levels in the arterial cord plasma and liquor amnii on the other hand implying that this substrate passes unutilized through the fetus to the liquor amnii. A pregnant woman in the third trimester should not withhold food for long periods.

Adult↗
PubMed1999

[Vaginal delivery following previous cesarean section].

BACKGROUND AND AIM: The increased use of cesarean section (CS) over the past 30 years has raised a problem which has been much debated in obstetric practice: is it always necessary to repeat CS in women who have previously undergone cesarean section? The aim of this study was to establish whether women previously undergoing CS can start trial labour? METHODS: The authors examined 195 pregnant women who had previously undergone 1 or 2 CS. Medical history, clinical examination and maternal and fetal monitoring techniques were used to select the women who could start trial labour.

Cesarean Section↗
PubMed1988

Vaginal birth after cesarean section: management debate.

Obstetric performance of 1847 women with previous cesarean section (CS) during the years 1983 and 1984 were studied. Vaginal birth after cesarean section (VBAC) was attempted in 94% of females with one previous CS, 4% in those with two previous CS, and one among the 70 patients with three or more previous CS. VBAC was achieved in 51% of those with one previous CS. It was successful in 60% of parturients with CS for non-recurrent causes, 36% of CS for cephalopelvic disproportion (CPD) and in 64% of those with a prior vaginal delivery. Uterine scar dehiscence was found in 0.9% of all patients with a previous CS. A failed attempt with Ventouse to achieve VBAC caused maximum maternal and perinatal morbidity.

Adolescent↗
PubMed1990

Vaginal delivery following one previous cesarean birth: nation wide survey.

The present state of vaginal delivery following a previous cesarean section (CS) was evaluated through a nation wide survey, including 22,815 deliveries. The overall cesarean rate was 9.6%. Of all the parturients with one previous cesarean section 55.1% delivered vaginally. A previous CS and labor arrest were the major indications for a repeated CS in 28.7% and 26.4%, respectively. Rupture of the uterus following vaginal delivery was found more often in the group with a previous CS than in those with no uterine scar (1.2% and 0.03%, respectively), (P less than 0.0001). None of the uterine ruptures was fatal neither to the mother nor to the fetus. Post partum fever appeared more often among vaginal deliveries following a CS than among those with no uterine scar. However, CS is followed by fever 10.8 times more than vaginal delivery. Intrapartum and neonatal death rates following vaginal delivery were similar for those with or without a previous CS (3.42% and 3.38%, respectively). An average of 3 hospitalization days were saved for each vaginal birth replacing a repeated CS. It is concluded that vaginal delivery, following CS, does not cause substantial morbidity, nor mortality either to the mother or the neonate, and may be practiced with a reasonable margin of safety in well selected cases.

Adolescent↗
PubMed1991

[Antibiotic prophylaxis in obstetric surgery. Experience with a sulbactam-ampicillin combination].

Antibiotic prophylaxis reduces the incidence of infections after some types of surgical interventions; in Obstetrics it can prevent infections in high risk situations. Infections can occur in particular situations, even in cesarean sections (CS) at low risk. The incidence of puerperal endometritis is variable in literature, while the incidence of pelvic or surgical wound infections is 3.8% in elective CS with respect to 7.5% in emergency CS. This study verifies the efficacy of the sulbactam-ampicillin association (Unasyn, Pfizer) in the prophylaxis of all cesarean sections, complicated or not. Unasyn was administrated one hour prior to CS and 8 and 16 hours after CS in 162 patients. Therapy was continued in 8 cases because of high risk for infection. The evaluation of the efficacy of the drug was based on clinical criteria. There were no complications or fever recorded and no toxic or allergic reactions occurred. Antibiotic prophylaxis is recommended for all patients undergoing CS.

Adult↗
PubMed1994

Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates.

OBJECTIVE: To compare the clinical indications for delivery by cesarean section (CS) in singleton pregnancies in two Danish counties with different CS rates, and to describe the relation between CS in the two counties and parity, mother's age, type of delivery department, gestational age at birth, and birthweight. DESIGN: A population-based, follow-up study based on antecedent data. SETTING: Two Danish counties, where women deliver in obstetric as well as surgical departments, with a CS rate of 8.3% and 15.2%, respectively. SUBJECTS: All pregnant women in the two counties who delivered in 1989. MAIN OUTCOME MEASURES: Comparison of the rates of CS in the two counties carried out for five well-defined clinical indications: Previous cesarean section, breech presentation, dystocia, fetal distress, and other. SECONDARY MEASURES: Neonatal and maternal outcomes. RESULTS: In the county with the higher frequency of CS, all indications for CS were used significantly more often, except from 'fetal distress' in primiparous women. In this county 'breech presentation' was the commonest indication among primiparous women, whereas 'fetal distress' was the most common in the county with the lower CS rate. For multiparous women the highest CS rates in both counties were found among women who had had a previous CS. The major difference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with the higher CS rate. CONCLUSION: The regional differences in CS could not be explained by differences between the two populations or by an increased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.

Adolescent↗
PubMed1999

[Cord blood insulin and erythropoietin levels in relation to the mode of delivery].

UNLABELLED: The aim of the study was evaluation, whether cord blood insulin (Ic) and erythropoietin (EPO) levels differ in accordance with mode of delivery: cesarean section (CS) or vaginal delivery (VD). MATERIAL AND METHODS: The study was performed in the diabetic group consisted of 148 newborns of diabetic mothers (NDM)--90 of them with GDM and 58 with IDDM as well as in the control group consisted of 100 newborns born to healthy mothers. 52.0% of NDM and 38.0% control subjects were delivered by cesarean section. The most frequent reason for performing CS in the diabetic group was fetal distress before labor and in the control group--fetal distress during labor. Cord blood Ic and EPO levels were compared in accordance with type of delivery: CS or VD. Into statistical analysis Mann-Whitney test was used. RESULTS: There were found that cord blood Ic and EPO levels in NDM born by CS are significantly higher than in those born by VD (Ic--38.2 +/- 41.5 versus 26.6 +/- 38.6 mIU/ml adequately and EPO--51.8 +/- 76.0 versus 26.8 +/- 29.9 mU/ml adequately). There were no such differences in the control group. CONCLUSIONS: 1. Fetal hyperinsulinemia in perinatal period is often connected with occurrence of indications for performing cesarean section in pregnant women with diabetes mellitus. 2. Cesarean section in diabetic pregnant women is often connected with previous fetal hypoxia.

Adult↗
PubMed1980

Effect of fetal monitoring on cesarean section rates.

Electronic fetal monitoring (EFM) and cesarean sections (CS) have been studied in 14,484 patients delivered between 1970 and 1975. The primary CS rate for those monitored was 107/1000, and for the unmonitored was 57/1000. Multivariate analysis of these data shows that most of the increase in CS rate associated with monitoring is attributable to inherent differences between monitored and unmonitored patients. Furthermore, the association between monitoring and CSs was not homogeneous among sub-groups. Cesarean sections were relatively less frequent in monitored nulliparas with malpresentation and more frequent in otherwise normal monitored multiparas. These opposing effects tended to balance each other. During the study period the primary CS rate rose from 4.3 to 11.2%. This increase was strong in unmonitored patients and was primarily due to operations undertaken for fetopelvic disproportion. We cannot therefore attribute much of the increasing CS rate at our hospital to fetal monitoring.

Cesarean Section↗
PubMed1984

The course of subsequent pregnancies after previous cesarean section.

The course of pregnancies subsequent to cesarean section (CS) was studied. During the years 1970-72, 543 women were delivered by CS at Borås Central Hospital. A questionnaire was sent to all 543 during the autumn of 1976 and the spring of 1977. The questions concerned further conceptions and the outcome of all subsequent pregnancies after CS. Of the 440 (81%) women who answered the questionnaire, 244 (55.5%) became pregnant, the total number of subsequent pregnancies being 306. The incidence of spontaneous abortion, extra-uterine pregnancy and legal abortion was not significantly higher than the corresponding rate for the total material for our department during the same period. Among the 215 women who completed a new pregnancy, an elective CS was performed in 81 cases (38%). Trial of labor occurred in 143 patients, 91 of whom (68%) gave birth per vaginam , while 43 (32%) were delivered by acute CS. In nearly half of the acute CS cases the indication was a narrow pelvis not detected until labor had started. This indicates that roentgenologic pelvimetry should be considered in certain cases, when planning delivery after a previous CS.

Abortion, Spontaneous↗
PubMed1996

[Retrospective study of postoperative infectious morbidity following cesarean section].

The increase of cesarean sections produced more postoperative infections. Several authors assessed the effectiveness of chemioantibiotic prophylaxis to reduce the postoperative infective morbidity. Although the family of antibiotics more frequently used is that of cephalosporin, the best single agent has not been found yet. The aim of our study, made in the Department of Obstetrics and Gynecology of University of Naples "Federico II", is to propose a retrospective analysis concerning the incidence of cesarean section (CS), the postoperative infective morbidity and the employment of antibiotic prophylaxis. Our sample is a group of 13285 pregnant women, 3171 (23.9%) of these patients underwent to CS from 1st January 1985 to 31st December 1994. The group of 3171 women was divided in two subgroups, the first of 2748 patients un-derwent to antibiotic prophylaxis, the second of 423 was untreated due to their previous experience of allergy towards antibiotics or because there was no evidence of risk factors. The women we treated with antibiotics underwent a three days prophylactic therapy with cefazolin or ampicillin soon after the CS. The incidence of infective complications had a 21.2% rate over a total of 3171 women. Endometritis was the most common infectious complication following cesarean delivery. The rate was 53.3% in the case of primary cesarean section and 52.3% in the case of iterative cesarean section. The use of antibiotic prophylaxis gave us the opportunity to reduce the postoperative morbidity in the primary CS (23.4%) as well in the iterative CS (16.6%). On the contrary the untreated group had an infective incidence with a 33.8% rate in the case of primary CS and with a 27.4% rate in the case of iterative CS. Our opinion is that the administration of antibiotics as cefazolin and ampicillin is able to reduce in a significant way the incidence of postoperative infective morbidity as well the period of hospitalization.

Adult↗
PubMed1995

Decrease in perinatal mortality and increase in cesarean section rates.

OBJECTIVES: To investigate the cesarean section (CS) rate in the Riyadh area, its trend and relationship to perinatal mortality (PNM). METHODS: Based on delivery data obtained from the Ministry of Health hospitals, Saudi Arabia, for a total of 12 years, yearly rates of CS, PNM and the ratios of obstetricians and beds per 10,000 population were computed for the Riyadh area and compared with the overall rates for Saudi Arabia. Correlation coefficients were used to investigate the relationship between the CS rate and each of the stated variables. RESULTS: Riyadh had significantly lower rates of CS and PNM than Saudi Arabia as a whole. The CS rate in Riyadh showed a positive trend (increasing from 4.4 to 6.7%) while the PNM rate revealed a significant decreasing trend (decreasing from 21.6/1000 to 16/1000 live births). A negative association existed between the Riyadh rates of PNM and CS (r = -0.2375) and PNM and the availability of obstetricians (r = -0.8693). CONCLUSIONS: From our data it was not possible to establish a cause and effect relationship between the CS and PNM rates.

Cesarean Section↗
PubMed1990

[The importance of the prophylactic use of antibiotics with women undergoing elective cesarean section].

Postoperative infectious morbidity was described in two groups of low risk cesarean sections (CS). The frequency of postoperative infectious complications was 6.89% of women, who received penicillin for a period of 3 to 5 days, but 5.67% of women, who did not received antibiotics prophylactically. Data were presented, which showed also the economic insignificance of antibiotic prophylaxis (AP) in women with low risk CS. On the basis of the indicated data an inference was made that AP was of no clinical efficiency in women with low risk cesarean sections. The authors recommend restraint in AP of such women, in whom postoperative infectious inflammatory complications are anyway very rare.

Anti-Bacterial Agents↗
PubMed1986

Continuous extraovular prostaglandin F2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery.

Late pregnancy termination by continuous extraovular instillation of prostaglandin F2 alpha (PGF2 alpha) was successfully performed in 13 patients with previous cesarean section (CS) delivery. The indications for pregnancy termination were intrauterine fetal demise in nine patients, social indications in two patients. Down's Syndrome in one patient and quadruplets pregnancy in one patient. One patient had a previous classical vertical cesarean section, two had two previous and one three previous low segment transverse (LST) cesarean sections. The other nine patients had one previous low segment transverse cesarean section. The instillation of prostaglandin solution was obtained by using a new double balloon catheter designed for extraovular pregnancy terminations. All patients aborted following the procedure with no complications. The instillation abortion time ranged from 5 1/2 to 20 h (mean 13.3 h).

Abortion, Therapeutic↗