The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673698112059.pdf

Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study

The effect of intrapartum ampicillin treatment on vertical transmission of group B streptococci (GBS) was examined in 575 prenatally colonized parturient women and their 580 newborn infants. Eighty women (43 receiving ampicillin) with premature labor and/or prolonged rupture of amniotic membranes were randomized. The other 495 were stratified into groups of 358 (31 receiving ampicillin) with no perinatal risk factors; 119 (28 receiving ampicillin) with premature labor and/or prolonged membrane rupture; and 23 (18 receiving ampicillin) with intrapartum fever. Ampicillin virtually eliminated vertical transmission in the treatment group with no risk factors and in both treatment groups with premature labor and/or prolonged membrane rupture. GBS colonization of neonates was detected only in women with intrapartum fever or brief (less than 1 hr) duration of treatment prior to delivery. Ampicillin treatment was associated with a highly significant reduction in maternal postpartum vaginal colonization by GBS. There were six group B streptococcal early-onset infections in infants of untreated subjects and no cases in treated subjects.

Selective Intrapartum Chemoprophylaxis of Neonatal Group B Streptococcal Early-Onset Disease. III. Interruption of Mother-to-Infant Transmission

Influence of persistent occiput posterior position on delivery outcome.

Human birth follows a pattern which is unique among mammals. Distinctions include the orientation of the fetus as it passes through the birth canal, the way the fetus emerges from the birth canal, difficulty during labor, and behavior by the mother and/or other individuals around the time of birth. Birth has important implications for the morphology of the pelvis, for sex differences in the pelvis, for such aspects of human biology as size (and maturity) at birth, and for behavior (including cooperative behavior). This paper reviews the fossil and comparative evidence for when and how the modern pattern of birth evolved.

The modern human pattern of birth evolved in a mosaic manner with some unique features appearing early in human evolution and others quite late. A human-like entry of the fetal head into the birth canal was already present among australopithecines as a result of their wide pelvic apertures. Other aspects of modern human birth such as the rotation of the head and body within the birth canal and the emergence of the fetal head in an occiput anterior position probably evolved later, when encephalization had placed increasing selection on both the form of the pelvis and the timing of birth. Cooperative behavior during and after birth accompanied the origin of the fully modern human mechanism of birth.

The unique phenomenon of modern human birth did not evolve in response to a single “obstetrical dilemma” but as part of a complex interplay between changes in a number of aspects of human biology. © 1992 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajpa.1330350605

The evolution of modern human childbirth

Active management of labour has been developed to the extent that an assurance is given to every woman who attends this hospital that her first baby will be born within 12 hours. This assurance could lead to a welcome change in present attitudes because the mere prospect of prolonged labour is often a cause of serious concern during a first pregnancy. Labour of strictly limited duration makes it possible to provide every woman with a personal nurse, and it places the problem of pain in a new setting.The results of a prospective study of 1,000 consecutive primigravidae are presented, and the guidelines to a standard policy of management are defined. Difficulty in meeting the commitment to early delivery arose almost exclusively in cases in which the diagnosis of labour was in doubt; only seven women were retained in the delivery unit for 12 hours.

https://www.bmj.com/content/bmj/3/5872/135.full.pdf

Kieran O'Driscoll

Papers

Active Management of Labour

Active management of labour.